Original Data

Pancreas Transplantation of US and Non-US Cases from 2005 to 2014 as Reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR)

Angelika C. Gruessner, Rainer W.G. Gruessner

Manuscript submitted October 20, 2015; resubmitted December 16, 2015; accepted December 19, 2015.

Keywords: diabetes, pancreas transplant, kidney, SPK, PAK, PTA, graft function, antibody induction

Abstract

This report is an update of pancreas and kidney transplant activities in the US and non-US region in two periods, 2005-2009 and 2010-2014. The aim of the report was to analyze transplant progress and success in the US compared to non-US countries, and to compare trends between the two periods. Between 2005-2009 and 2010-2014, the number of US pancreas transplants declined by over 20%, while the overall number of pancreas transplants performed outside the US has increased. The decline in US numbers is predominantly due to the decline in primary and secondary pancreas after kidney transplants (PAK). During the time period studied, the number of PAK transplants dropped by 50%. In contrast, the number of simultaneous pancreas/kidney transplants (SPK) declined by only 10%, and the number of pancreas transplants alone (PTA) by 20%. Over 90% of pancreas transplants worldwide were performed, with a simultaneous kidney transplant and excellent results. Transplant outcomes in SPK improved significantly because of a decrease in the rates of technical and immunologic graft loss. In 2010-2014 vs. 2005-2009, US SPK transplant patient survival at 1 year post-transplant increased from 95.7% to 97.4%, pancreas graft function from 88.3% to 91.3%, and kidney function from 93.6% to 95.5%. A significant improvement was also noted in PAK transplants. One-year patient survival increased from 96.4% to 97.9% and pancreas graft function from 81.0% to 86.0%. PTA 1-year patient survival remained constant at 97%, and pancreas 1-year graft survival improved from 81.0% to 85.7%. With the decline in the number of transplants, a change towards better pancreas donor selection was observed. In solitary transplants, the donors were primarily young trauma victims, and the pancreas preservation time was relatively short. A general tendency towards transplanting older recipients was noted. In 2010-2014 vs. 2005-2009, PTA recipients 50 years of age or older accounted for 32% vs. 22%, PAK for 28% vs. 22%, and SPK for 22% vs. 20%. This may be due to a relatively lower immunologic graft loss rate, especially in solitary transplants, which historically has been high in young recipients. The number of pancreas transplants in patients with type 2 diabetes and end-stage renal disease has increased, and accounted for 9% of all SPK recipients in 2010-2014.

Fulltext: HTML , PDF (1.7 MB)

This article has been cited by other articles:

	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 Gruessner AC, Laftavi MR, Pankewycz O, Gruessner RW Curr Diabetes Rep 2017. 17(6):44
	Cell Therapy for Type 1 Diabetes: Current and Future Strategies Aghazadeh Y, Nostro MC Curr Diabetes Rep 2017. 17(6):37
	A single-centre experience of Roux-en-Y enteric drainage for pancreas transplantation Amin I, Butler AJ, Defries G, Russell NK, Harper SJ, Jah A, Saeb-Parsy K, Pettigrew GJ, Watson CJ Transpl Int 2017. 30(4):410-419
	Islet cell transplant: Update on current clinical trials Schuetz C, Markmann JF Curr Transplant Rep 2016. 3(3):254-263
	Comment on the Article "OPTN/SRTR 2015 Annual Data Report: Pancreas" Gruessner AC, Gruessner RW Am J Transplant 2017. In press
	The study of factors that affect pancreatic graft survival for improving long term outcomes of pancreas transplantation in Japan Ito T, Kenmochi T, Aida N, Ito T Jap J Transplant 2016. 51(4-5):355-370
	The future of pancreas transplantation: 'ain't what it used to be' Stratta RJ Curr Opin Organ Transplant 2016. 21(4):375-376
	Long-term outcome after pancreas transplantation: a registry analysis Gruessner AC, Gruessner RW Curr Opin Organ Transplant 2016. 21(4):377-385
	Exocrine drainage in vascularized pancreas transplantation in the new millennium El-Hennawy H, Stratta RJ, Smith F World J Transplant 2016. 6(2):255-271
	Diabetes and other endocrine-metabolic abnormalities in the long-term follow-up of pancreas transplantation Lauria MW, Ribeiro-Oliveira A Jr Clin Diabetes Endocrinol 2016. 2:14