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Outcomes of pancreas transplantation in older versus younger recipients: a comparative analysis

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Abstract

Purpose

The feasibility of pancreas transplantation (PT) in older recipients remains a matter of debate. We examined the influence of recipient age on PT outcomes and identified the prognostic factors for older recipients.

Methods

We compared the outcomes of PT in recipients aged < 50 years (younger group; n = 285) with those in recipients aged ≥ 50 years (older group; n = 94). Prognostic factors in the older group were analyzed by a logistic regression model and the influence of recipient age on survival outcomes were analyzed using propensity score matching.

Results

The patient survival rate was significantly worse in the older group (P < 0.001). Patient death from infection or/and multiple organ failure or cardiac/cerebrovascular events was also more frequent in the older group than in the younger group (P = 0.012 and P = 0.045, respectively). A longer duration of diabetes was an independent risk factor of 1-year mortality in the older group. In a propensity score-matched comparison, the older recipients (n = 77) had significantly poorer survival than the younger recipients (n = 77) (P = 0.026).

Conclusions

PT should be considered with appropriate caution, especially for older recipients with a long duration of diabetes.

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Abbreviations

BMI:

Body mass index

DBD:

Donation after brain death

CIT:

Cold ischemia time

CPR:

Cardiopulmonary resuscitation

DCD:

Donation cardiac death

HR:

Hazard ratio

OR:

Odds ratio

PAK:

Pancreas after kidney

PT:

Pancreas transplantation

PTA:

Pancreas transplant alone

ROC:

Receiver operating characteristic

SPK:

Pancreas and kidney transplantation

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Acknowledgements

We thank Dr. Masaaki Watanabe and Dr. Yasuyuki Koshizuka (Hokkaido University Hospital), Dr Shigehito Miyagi and Dr. Kazuaki Tokodai (Tohoku University Hospital), Dr. Takuro Saito and Dr. Akira Kenjo (Fukushima Medical University Hospital), Dr. Keiichi Kubota and Dr. Masato Kato (Dokkyo Medical University Hospital), Dr. Ichiro Nakajima and Dr. Ichiro Koyama (Tokyo Women’s Medical University Hospital), Dr. Shigeyuki Kawachi and Dr. Hitoshi Iwamoto (Tokyo Medical University Hachioji Medical Center), Dr. Michihiro Maruyama and Dr. Kazunori Otsuki (National Chiba-Higashi Hospital), Dr. Toshifumi Wakai and Dr. Takashi Kobayashi (Niigata University Hospital), Dr. Shunji Narumi and Dr. Takahisa Hiramitsu (Nagoya Daini-Red Cross Hospital), Dr. Hidetaka Ushigome and Dr. Shuji Nobori (Kyoto Prefectural University Hospital), Dr. Hideaki Okajima and Dr. Takayuki Anazawa (Kyoto University Hospital), Dr. Hidetoshi Eguchi and Dr. Yoshito Tomimaru (Osaka University Hospital), Dr. Hirochika Toyama and Dr. Sachio Terai (Kobe University Hospital), Dr. Hideki Ohdan and Dr. Hiroyuki Tahara (Hiroshma University Hospital), Dr. Keiichi Okano and Dr. Minoru Oshima (Kagawa University Hospital), Shinichiro Ono and Tomohiko Adachi (Nagasaki University Hospital) and Dr. Keizo Kaku and Dr. Yasuhiro Okabe (Kyushu University Hospital) for their cooperation with the registry of Japanese Pancreas Transplantation.

Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukakecho, Toyoake-shi, Aichi, 470-1192, Japan

    Hajime Matsushima, Taihei Ito, Naohiro Aida, Kei Kurihara & Takashi Kenmochi

  2. Japan Society for Pancreas and Islet Transplantation, The Japan Pancreas Transplant Registry, Osaka, Japan

    Yoshito Tomimaru & Toshinori Ito

Authors
  1. Hajime Matsushima
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  2. Taihei Ito
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  3. Naohiro Aida
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  4. Kei Kurihara
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  5. Yoshito Tomimaru
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  6. Toshinori Ito
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  7. Takashi Kenmochi
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Contributions

HM, TK, IT, and NA conceptualized the idea and design of the study. HM, TK, IT, NA, KK, YT, and TI participated in data collection, analysis, and interpretation. HM, and IT wrote the article. HM, TK, IT, and NA, revised the article. All authors approved the final draft.

Corresponding author

Correspondence to Hajime Matsushima.

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Matsushima, H., Ito, T., Aida, N. et al. Outcomes of pancreas transplantation in older versus younger recipients: a comparative analysis. Surg Today 51, 1655–1664 (2021). https://doi.org/10.1007/s00595-021-02284-8

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