title: Similar results with solitary pancreas transplantation compared with simultaneous pancreas-kidney transplantation in the new millennium.
abstract: BACKGROUND
  The purpose of this study was to analyze our single-center outcomes according to pancreas transplant (PT) category in the new millennium by using standardized management protocols.
  
  
  METHODS
  We retrospectively studied 202 consecutive PTs (179 with portal-enteric drainage) in 192 patients; all received either rabbit antithymocyte globulin or alemtuzumab induction in combination with tacrolimus, mycophenolate mofetil, and tapered corticosteroids or early steroid withdrawal. Unlike simultaneous pancreas/kidney (SPK) transplant, solitary PT (SPT) recipients were managed with routine perioperative anticoagulation and surveillance pancreas biopsies.
  
  
  RESULTS
  From November 2001 to March 2013, we performed 162 SPK transplants, 35 pancreas after kidney transplants, and 5 pancreas-alone transplants (40 SPTs). Demographic characteristics were mostly comparable; however, the SPT group had younger donors, shorter waiting time, fewer HLA mismatches, and fewer African-American recipients but more retransplants (all, P < .05). With a mean follow-up of 5.5 versus 7.5 years, overall patient (86.4% SPK vs 86.8% SPT), kidney graft (74% SPK vs 80% SPT), and pancreas graft (both 65%) survival rates were comparable. Although mortality rates were similar, mortality patterns differed because no SPT recipients died early, whereas the 1-, 3-, and 5-year mortality rates after SPK transplant were 4%, 9% and 12%, respectively (P < .05). The most common causes of pancreas graft loss were death with functioning grafts in SPK recipients and acute/chronic rejection in SPT recipients. Rates of early thrombosis were 8.6% in SPK patients and 5% in SPT patients. Cumulative clinical acute rejection rates were similar between groups (SPK 29% vs SPT 27.5%; P = NS).
  
  
  CONCLUSIONS
  In the setting of depleting antibody induction and tacrolimus-based therapy, HLA matching, careful donor and recipient selection, portal-enteric drainage, selective perioperative anticoagulation, and surveillance SPT biopsy monitoring, similar medium-term outcomes can be achieved in SPK transplants and SPTs in the new millennium.
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina. Electronic address: rstratta@wakehealth.edu.
authors.forename: R J
authors.initials: RJ
authors.lastname: Stratta
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: A C
authors.initials: AC
authors.lastname: Farney
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: G
authors.initials: G
authors.lastname: Orlando
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: U
authors.initials: U
authors.lastname: Farooq
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: Y
authors.initials: Y
authors.lastname: Al-Shraideh
authors.affiliation: Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina.
authors.forename: J
authors.initials: J
authors.lastname: Rogers
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D016035:Pancreas Transplantation / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013927:Thrombosis / Q000453:epidemiology