The Current State of Pancreas Transplantation in the USA—A Registry Report
- 28 Downloads
A successful pancreas transplantation is still the only method to provide long-term insulin independence and provide good metabolic control for patients with type I diabetes. Since the first pancreas transplant in 1966, the patient and graft survival after pancreas transplantation improved significantly. The aim of this report was to study the most recent outcome of pancreas transplants.
Between 2011 and 2016, 5159 primary deceased donor pancreas transplants in diabetic patients were performed—4342 (84%) SPK, 399 PAK (8%), and 418 (8%) PTA. One-year (3-year) SPK patient survival reached 98% (95%), PAK 97% (93%), and PTA 98% (96%). The most influential risk factor for patient survival in all three categories was a failed graft. In SPK, older recipients and being on dialysis at the time of transplant also carried an increased risk to die. SPK pancreas graft function improved to 90% at 1-year and 83% at 3-year post-transplant; 87% and 74% for PAK; and 84% and 71% for PTA. One-year (3-year) kidney graft function for the simultaneous SPK kidney was 96% (90%). The difference in outcome between SPK and solitary transplants is still significant but the gap is narrowing. A risk factor for pancreas graft failure was especially young recipient age, but a careful donor selection can improve outcome. The majority of recipients received depleting antibodies for induction followed by a maintenance protocol of Tacrolimus in combination with MMF. Steroids were used more often in SPK (70%) compared to solitary pancreas transplants.
In summary, outcome after pancreas transplantation has significantly improved due to refinement in immunosuppressive protocols and better donor and recipient selection. It can be successfully performed in patients with labile diabetes and will not only improve the quality of life of the patient but also can be life extending.
KeywordsPancreas transplantation Simultaneous pancreas kidney transplants (SPK) Pancreas after kidney transplant (PAK) Pancreas transplants alone (PTA) Patient survival Graft survival Immunological graft loss Technical complications
Compliance with Ethical Guidelines
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 1.Center for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta: Dept of Health and Human Services; 2017.Google Scholar
- 2.• Nathan DM for the DCCT/EDIC Research group. The diabetes control and complication trial/epidemiology of diabetes intervention and complications study at 30 years: overview. Diabetes Care. 2014;37:9–16. The results of the DCCT/EDIC trial are important for the understanding that pancreas transplantation is need and is not obsolete. CrossRefGoogle Scholar
- 11.•• Stratta RJ, Gruessner AC, Odorico JS, Fridell JA, Gruessner RW. Pancreas transplantation: an alarming crisis in confidence. Am J Transplant. 2016;16(9):2556–62. Ongoing discussion about the use and changes in pancreas transplantation should be continue to provide the best possible diabetes care for patients. CrossRefGoogle Scholar
- 15.• McCoy RG, Van Houten HK, Ziegenfuss JY, Shah ND, Wermers RA, Smith SA. Increased mortality of patients with diabetes reporting severe hypoglycemia. Diabetes Care. 2012;35(9):1897–901. Hypoglycemic unawareness is still a major problem in conservative diabetes treatment and effect on patient survival cannot be neglected. CrossRefGoogle Scholar
- 19.• Gruessner AC, Laftavi MR, Pankewycz O, Gruessner RWG. Simultaneous pancreas and kidney transplantation-is it a treatment option for patients with type 2 diabetes mellitus? An analysis of the international pancreas transplant registry. Curr Diab Rep. 2017;17(6):44. Comprehensive look at the use of pancreas transplantation for patients with type 2 diabetes mellitus. CrossRefGoogle Scholar
- 20.•• Maglione M, Ploeg RJ, Friend PJ. Donor risk factors, retrieval technique, preservation and ischemia/reperfusion injury in pancreas transplantation. Curr Opin Organ Transplant. 2013;18(1):83–8. Very nice comprehensive overview over the current status of pancreas transplantation. CrossRefGoogle Scholar
- 22.Rudolph EN, Dunn TB, Sutherland DER, Kandaswamy R, Finger EB. Optimizing outcomes in pancreas transplantation: impact of organ preservation time. Clin Transpl. 2017;31(9).Google Scholar