title: Diabetes Mellitus in Living Pancreas Donors: Use of Integrated National Registry and Pharmacy Claims Data to Characterize Donation-Related Health Outcomes.
abstract: Living donor pancreas transplant is a potential treatment for diabetic patients with end-organ complications. Although early surgical risks of donation have been reported, long-term medical outcomes in living pancreas donors are not known.
  
  
  
  We integrated national Scientific Registry of Transplant Recipients data (1987-2015) with records from a nationwide pharmacy claims warehouse (2005-2015) to examine prescriptions for diabetes medications and supplies as a measure of postdonation diabetes mellitus. To compare outcomes in controls with baseline good health, we matched living pancreas donors to living kidney donors (1:3) by demographic traits and year of donation.
  
  
  
  Among 73 pancreas donors in the study period, 45 were identified in the pharmacy database: 62% women, 84% white, and 80% relatives of the recipient. Over a mean postdonation follow-up period of 16.3 years, 26.7% of pancreas donors filled prescriptions for diabetes treatments, compared with 5.9% of kidney donors (odds ratio, 4.13; 95% confidence interval, 1.91-8.93; P = 0.0003). Use of insulin (11.1% vs 0%) and oral agents (20.0% vs 5.9%; odds ratio, 4.50, 95% confidence interval, 2.09-9.68; P = 0.0001) was also higher in pancreas donors.
  
  
  
  Diabetes is more common after living pancreas donation than after living kidney donation, supporting clinical consequences from reduced endocrine reserve.
authors.affiliation: 1 Division of Nephrology, University of Alberta, Edmonton, AB, Canada. 2 Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO. 3 Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. 4 Symphony Health Solutions, Leonard Davis Institute for Health Economics, Philadelphia, PA. 5 Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA. 6 Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN. 7 Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN. 8 Division of Abdominal Transplantation, Department of Surgery, Brody School of Medicine, Greenville, NC. 9 Division of Nephrology, Western University, London, ON, Canada. 10 Transplant Nephrology, Washington University School of Medicine, St. Louis, MO.
authors.forename: Ngan N
authors.initials: NN
authors.lastname: Lam
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schnitzler
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
authors.forename: Gregory P
authors.initials: GP
authors.lastname: Hess
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.forename: Henry B
authors.initials: HB
authors.lastname: Randall
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
authors.forename: Huiling
authors.initials: H
authors.lastname: Xiao
authors.forename: Amit X
authors.initials: AX
authors.lastname: Garg
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Brennan
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
mesh_terms: D000067575:Administrative Claims, Healthcare; D000328:Adult; D057225:Data Mining; D016208:Databases, Factual; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology*; D005260:Female; D006304:Health Status; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007356:Insurance, Pharmaceutical Services; D016030:Kidney Transplantation / Q000009:adverse effects; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods; D010180:Pancreatectomy / Q000009:adverse effects*; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D061349:Unrelated Donors
chemical_list: D007004:Hypoglycemic Agents