Pancreas Transplant Registry Report – 1986

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Abstract
From 1966 to August, 1986, 972 pancreas transplants in 907 diabetic patients were reported to the International Pancreas Transplant Registry. One‐year actuarial graft function (insulin‐independent) and recipient survival rates for all cases were 34% and 75%, respectively. In an analysis by era of 1966–77 (n = 64), 1978–82 (n = 201), 1983–84 (n = 298) and 1985–86 (n = 409) cases, 1‐yr graft function rates were 3%, 20%, 38% and 46% and recipient survival rates were 42%, 71%, 75% and 85%, respectively (p < 0.05 all comparisons). In an analysis of 1983–1986 cases only (n = 707), the overall 1‐yr graft function and patient survival rates were 42% and 80%, respectively. During this period, graft functional survival rates were similar (p > 0.02) for the most common duct management methods, 46% for duct injection (n = 247), 42% for enteric drainage (n = 206), and 40% for bladder drainage (n = 179) at 1 yr. Graft function rates were also similar (p > 0.2) for whole (n = 263) and segmental (n = 444) pancreas transplants (39% vs 43% at 1 yr). Functional survival rates according to duration of preservation for grafts stored < 6 h (n = 437), 6–12 h (n = 151) and > 12 h (n = 34) were 45%, 36%, and 40% at 1 yr, and the difference was significant for the < 6 vs the 6–12 h preservation time (p = 0.004). Graft functional survival rates were significantly higher (p < 0.05) in recipients who received azathioprine (AZA) and cyclosporine (CSA) in combination (n = 364) than in those who received CSA without azathioprine (n = 258) or AZA without cyclosporine, (n = 73), with 1‐yr graft functional survival rates of 47%, 38% and 31%, respectively. For technically successful grafts, the functional survival rates were also significantly higher (p < 0.05) in recipients treated with CSA‐AZA (n = 282) than in those who received CSA without azathioprine (n = 181) or AZA without cyclosporine (n = 49), with 1‐yr function rates of 62%, 53% and 45%, respectively. The combination of CSA and AZA did not have a detrimental effect on patient survival; for all cases, the 1‐yr survival rate for recipients treated with both CSA and AZA was 88%, versus 76% in those treated with CSA without azathioprine and 64% in those treated with AZA without cyclosporine (p < 0.05). Kidneys were transplanted in 583 (82%) of the 707 recipients of pancreas transplants in 1983–86; pancreas graft survival rates were significantly higher (p < 0.05) in recipients of simultaneous kidney transplants (n = 447) than in recipients of pancreas transplants after a kidney (n = 135) or recipients of pancreas transplants alone (n = 124), at 1 yr 49%, 32%, and 28%, respectively. Patient survival rates, however, were significantly higher (p < 0.05) in recipients of pancreas transplants alone (87% at 1 yr) than in recipients of simultaneous pancreas and kidney transplants (76% at 1 yr); the survival rate of recipients of pancreas transplants after a kidney (86% at 1 yr) did not significantly differ from that in the other two groups. The renal graft functional survival rate for kidneys transplanted simultaneously with a pancreas was 66% at 1 yr. If the improvement in pancreas transplant results continues, pancreas graft functional survival rates will eventually approach those of other solid organs.
Funding Information
  • University of Minnesota

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