title: Long-term outcomes of pancreas after kidney transplantation in small centers: is it justified?
abstract: BACKGROUND
  Currently, the long-term advantages of having a pancreas transplantation (PT) are debated, particularly in patients receiving pancreas after kidney (PAK) allografts. The United Network for Organ Sharing (UNOS) requires that a transplant center perform a minimum number of PT per year to remain an active PT center. The long-term outcomes and challenges of PAK in small pancreas transplant centers are not well studied.
  
  
  METHODS
  In this retrospective analysis, we report short- and long-term outcomes in a small center performing 2-9 PT annually.
  
  
  RESULTS
  Forty-eight PT (25 simultaneous pancreas and kidney transplantation [SPK], 23 PAK) were performed in our center. Donor and recipient demographics were similar in both groups. All suitable local donors were used for SPK. All organs for PAK transplantation were imported from other UNOS regions. Mean follow-up was 61 ± 46 and 74 ± 46 months for SPK and PAK, respectively. Patient and graft survival rates were similar in SPK and PAK groups and better than the reported national average. Four patients (11%) died (1 due to trauma, 1 brain lymphoma, 1 ruptured aneurysm; and 1 unknown cause). Two patients (4%; 1 SPK, 1 PAK) lost their grafts because of thrombosis on postoperative days 3 and 5 in 2002. No graft thrombosis occurred since 2002. Seven patients (15%) required reoperation (4 for bleeding, 2 anastomotic leaks, 1 small bowel perforation). Two patients (4%) developed post-transplantation lymphoproliferative disease. Five patients (11%) experienced cytomegalovirus antigenemia which responded well to antiviral therapy.
  
  
  CONCLUSIONS
  Compared with outcomes for diabetic patients on dialysis, current SPK and PAK short- and long-term results are favorable even in a small PT center. Therefore, unless there is a contraindication, PT should be offered to all type 1 diabetic patients with end-stage renal disease at the time of kidney transplantation or afterward.
authors.affiliation: Department of Surgery, State University of New York, Buffalo, New York. Electronic address: mlaftavi@buffalo.edu.
authors.forename: M R
authors.initials: MR
authors.lastname: Laftavi
authors.affiliation: Department of Medicine, State University of New York, Buffalo, New York.
authors.forename: O
authors.initials: O
authors.lastname: Pankewycz
authors.affiliation: Department of Surgery, University of Arizona, Tuscon, Arizona.
authors.forename: A
authors.initials: A
authors.lastname: Gruessner
authors.affiliation: Department of Medicine, State University of New York, Buffalo, New York.
authors.forename: Murray
authors.initials: M
authors.lastname: Brian
authors.affiliation: Department of Medicine, State University of New York, Buffalo, New York.
authors.forename: R
authors.initials: R
authors.lastname: Kohli
authors.affiliation: Department of Surgery, State University of New York, Buffalo, New York.
authors.forename: L
authors.initials: L
authors.lastname: Feng
authors.affiliation: Department of Surgery, State University of New York, Buffalo, New York.
authors.forename: M
authors.initials: M
authors.lastname: Said
authors.affiliation: Department of Surgery, State University of New York, Buffalo, New York.
authors.forename: R
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Surgery, State University of New York, Buffalo, New York.
authors.forename: S
authors.initials: S
authors.lastname: Patel
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D003587:Cytomegalovirus / Q000276:immunology; D003586:Cytomegalovirus Infections / Q000150:complications; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008232:Lymphoproliferative Disorders / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011183:Postoperative Complications; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology; D014481:United States / Q000453:epidemiology
chemical_list: D000956:Antigens, Viral