title: Mortality in diabetes: pancreas transplantation is associated with significant survival benefit.
abstract: BACKGROUND
  Pancreas transplantation in complicated type 1 (insulin dependent) diabetes mellitus improves the quality of life, increases longevity and stabilizes diabetic complications. There may be clinician reticence due to perceived poor outcomes with published associated mortality rates of 5-8% due to significant co-morbidities, particularly cardiovascular impairment.
  
  
  METHODS
  Retrospective analysis was performed on patients undergoing pancreas transplantation in a single centre since the programme's initiation [simultaneous pancreas kidney (SPK) = 148, pancreas after kidney (PAK) = 33 and pancreas transplant alone (PTA) = 11] compared with a control group accepted contemporaneously onto the waiting list. The primary endpoint was patient mortality. The risk factors including medical and diabetic history, demographics, transplant type and waiting time were analysed.
  
  
  RESULTS
  The waiting list mortality was 30% (35 of 120) compared with a mortality of 9% (20 of 193) post-transplantation (P < 0.001). Deaths on the waiting list compared with transplantation up to 1 year had a relative risk of 2.67 (95% CI: 0.81-3.51; P = 0.19), whilst those surviving >1 year had a relative risk of 5.89 of dying on the waiting list (95% CI: 1.70-3.20; P < 0.0005). There were no differences in terms of cardiovascular or renal-associated risk factors, nor in other potential confounding factors other than duration of diabetes (P = 0.02). Median survival from listing was shorter in younger patients (<50; P < 0.0001).
  
  
  CONCLUSIONS
  Type 1 diabetics with renal failure listed for pancreas transplantation are at a significant risk of mortality even without surgery. Transplantation offers considerable survival benefits, despite associated surgical and immunosuppressive risks. In selected patients, pancreas transplantation remains the benchmark treatment for type 1 diabetes mellitus.
authors.affiliation: Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester, UK. david.vandellen@cmft.nhs.uk
authors.forename: David
authors.initials: D
authors.lastname: van Dellen
authors.forename: Judith
authors.initials: J
authors.lastname: Worthington
authors.forename: Otilia M
authors.initials: OM
authors.lastname: Mitu-Pretorian
authors.forename: Abbas
authors.initials: A
authors.lastname: Ghazanfar
authors.forename: Bence
authors.initials: B
authors.lastname: Forgacs
authors.forename: Ravi
authors.initials: R
authors.lastname: Pararajasingam
authors.forename: Babatunde
authors.initials: B
authors.lastname: Campbell
authors.forename: Neil R
authors.initials: NR
authors.lastname: Parrott
authors.forename: Titus
authors.initials: T
authors.lastname: Augustine
authors.forename: Afshin
authors.initials: A
authors.lastname: Tavakoli
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000401:mortality*; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D015996:Survival Rate; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents
keywords: cardiovascular disease; end-stage renal disease; insulin-dependent diabetes mellitus; mortality; pancreas transplantation