title: Pancreas retransplantation:  a second chance for diabetic patients?
abstract: BACKGROUND
  If pancreas transplantation is a validated alternative for type 1 diabetic patients with end-stage renal disease, the management of patients who have lost their primary graft is poorly defined. This study aims at evaluating pancreas retransplantation outcome.
  
  
  METHODS
  Between 1976 and 2008, 569 pancreas transplantations were performed in Lyon and Geneva, including 37 second transplantations. Second graft survival was compared with primary graft survival of the same patients and the whole population. Predictive factors of second graft survival were sought. Patient survival and impact on kidney graft function and survival were evaluated.
  
  
  RESULTS
  Second pancreas survival of the 17 patients transplanted from 1995 was close to primary graft survival of the whole population (71% vs. 79% at 1 year and 59% vs. 69% at 5 years; P=0.5075) and significantly better than their first pancreas survival (71% vs. 29% at 1 year and 59% vs. 7% at 5 years; P=0.0008) regardless of the cause of first pancreas loss. The same results were observed with all 37 retransplantations. Survival of second simultaneous pancreas and kidney transplantations was better than survival of second pancreas after kidney. Patient survival was excellent (89% at 5 years). Pancreas retransplantation had no impact on kidney graft function and survival (100% at 5 years).
  
  
  CONCLUSIONS
  Pancreas retransplantation is a safe procedure with acceptable graft survival that should be proposed to diabetic patients who have lost their primary graft.
authors.affiliation: Service de Néphrologie, Médecine de Transplantation et d'Immunologie Clinique, Hôpital Edouard Herriot, Lyon, France. fanny.buron@chu-lyon.fr
authors.forename: Fanny
authors.initials: F
authors.lastname: Buron
authors.forename: Olivier
authors.initials: O
authors.lastname: Thaunat
authors.forename: Sandrine
authors.initials: S
authors.lastname: Demuylder-Mischler
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.forename: Maria
authors.initials: M
authors.lastname: Brunet
authors.forename: Charles-Eric
authors.initials: CE
authors.lastname: Ber
authors.forename: Charles
authors.initials: C
authors.lastname: Thivolet
authors.forename: Xavier
authors.initials: X
authors.lastname: Martin
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005602:France; D006084:Graft Rejection / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000276:immunology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013557:Switzerland; D013997:Time Factors; D016896:Treatment Outcome