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  • Title: Pancreas transplants for United States (US) and non-US cases as reported to the International Pancreas Transplant Registry (IPTR) and to the United Network for Organ Sharing (UNOS).
    Author: Gruessner AC, Sutherland DE.
    Journal: Clin Transpl; 1997; ():45-59. PubMed ID: 9919390.
    Abstract:
    As of November 1997 more than 9,800 pancreas transplants had been reported to the IPTR, including more than 7,400 US and more than 2,400 non-US cases. Cases reported since the inception of UNOS in 1987 (more than 6,800 in the US and more than 2,000 from outside the US) were analyzed, with emphasis on 1994-97 cases. In the US, for all 1994-97 SPK transplants (n = 2,585), one-year patient, pancreas and kidney graft survival rates were 94%, 82% and 90%, respectively; for all PAK cases (n = 230), patient and graft survival rates at one year were 95% and 71%; and for all PTA cases (n = 117), patient and graft survival rates at one year were 93% and 62%, respectively. The 1994-97 pancreas survival rates in all categories were significantly higher than in previous eras. Analysis of bladder versus enteric drainage (BD vs ED) was made only for 1994-97 SPK cases since there were too few solitary ED cases for a comparison. One-year pancreas survival rates (all causes of failure included) were 83% for BD (n = 1,995) versus 80% for ED (n = 456) cases (p = NS). However, nearly 20% of SPK BD grafts had been converted to ED by 2 years. The pancreas retransplant success rates have also significantly increased over time. For 1994-97 pancreas retransplants (n = 92), the one-year graft survival rate was 72%. The technical failure (TF) rate for pancreas transplants has declined over time. For 1994-96 BD cases, the TF rate was 8% in SPK (n = 1,995), 13% in PAK (n = 174) and 11% in PTA (n = 90) cases. For SPK ED cases (n = 456) the TF rate was 11% (p = 0.06 vs SPK BD). The most common cause of technical loss was graft thrombosis, 5.5% for SPK, 10.2% for PAK and 6.7% for PTA. The TF rates were significantly higher in grafts from older (> 45 yrs) donors and donors who died from cardiovascular disease. The immunological graft loss rate has also significantly declined in all categories. For 1994-97, technically successful (TS) cases (DWFG censored), the rejection loss rate at one year was 2% in the SPK (n = 2,234), 9% in the PAK (n = 154), and 16% in the PTA (n = 78) categories. Cox multivariate analyses were done in each recipient category to assess for factors that influence risks of pancreas graft loss. Increasing donor age was a risk factor in all categories. HLA mismatching was important only in the solitary (PAK and PTA) categories. FK506 use was associated with a positive effect in all categories, as was MMF in the SPK category.
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