title: Pancreas Transplantation: An Alarming Crisis in Confidence.
abstract: In the past decade, the annual number of pancreas transplantations performed in the United States has steadily declined. From 2004 to 2011, the overall number of simultaneous pancreas-kidney (SPK) transplantations in the United States declined by 10%, whereas the decreases in pancreas after kidney (PAK) and pancreas transplant alone (PTA) procedures were 55% and 34%, respectively. Paradoxically, this has occurred in the setting of improvements in graft and patient survival outcomes and transplanting higher-risk patients. Only 11 centers in the United States currently perform ≥20 pancreas transplantations per year, and most centers perform <5 pancreas transplantations annually; many do not perform PAKs or PTAs. This national trend in decreasing numbers of pancreas transplantations is related to a number of factors including lack of a primary referral source, improvements in diabetes care and management, changing donor and recipient considerations, inadequate training opportunities, and increasing risk aversion because of regulatory scrutiny. A national initiative is needed to "reinvigorate" SPK and PAK procedures as preferred transplantation options for appropriately selected uremic patients taking insulin regardless of C-peptide levels or "type" of diabetes. Moreover, many patients may benefit from PTAs because all categories of pancreas transplantation are not only life enhancing but also life extending procedures.
authors.affiliation: Department of Surgery, Section of Transplantation, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: R J
authors.initials: RJ
authors.lastname: Stratta
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: A C
authors.identifier: 0000-0001-5961-5913
authors.initials: AC
authors.lastname: Gruessner
authors.affiliation: Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.
authors.forename: J S
authors.initials: JS
authors.lastname: Odorico
authors.affiliation: Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: J A
authors.initials: JA
authors.lastname: Fridell
authors.affiliation: Department of Surgery, SUNY Upstate Medical University, Syracuse, NY.
authors.forename: R W G
authors.identifier: 0000-0002-2094-9817
authors.initials: RW
authors.lastname: Gruessner
mesh_terms: D006084:Graft Rejection / Q000401:mortality*; D006085:Graft Survival; D006801:Humans; D016035:Pancreas Transplantation / Q000401:mortality*; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D014481:United States
keywords: clinical research/practice; diabetes; donors and donation: deceased; editorial/personal viewpoint; kidney transplantation/nephrology; organ procurement; organ procurement and allocation; pancreas/simultaneous pancreas-kidney transplantation; patient referral; recipient selection