PANCREAS TRANSPLANT REGISTRY - HISTORY AND ANALYSIS OF CASES 1966 TO OCTOBER 1986

  • 1 January 1987
    • journal article
    • research article
    • Vol. 2  (4) , 473-488
Abstract
From December 1966 to October 1986, 1001 pancreas transplants in 932 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 35% 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 = 438) cases, 1 year graft function rates were 3, 21, 39, and 44% and recipient survival rates were 42, 72, 76, and 83, respectively (p < 0.05 all comparisons, except 1983-84 vs. 1985-86). In an analysis of 1983-1986 cases only (n = 736), the overall 1 year graft function and patient survival rates were 42 and 79%, respectively. During this period, graft functional survival rates were similar (p < 0.8) for the most common duct management methods, 43% for duct injection (n = 254), 42% for enteric drainage (n = 254), and 47% for bladder drainage (n = 196) at 1 year. Graft function rates were also similar (p < 0.6) for whole (n = 280) and segmental (n = 456) pancreas transplants (41 vs. 42% at 1 year). Functional survival rates according to duration of preservation for grafts stored < 6h (n = 460), 6-12 h (n = 146) and .gtoreq. 12 h (n = 52) were 46, 39, and 30% at 1 year, and the difference was significant for the < 6 vs. the 6-12 h preservation time (p = 0.023). Graft functional survival rates were significantly higher (p < 0.05) in recipients who received azathioprine (AZA) and cyclosporine (CSA) in combination (n = 408) than in those who received CSA without azathioprine (n = 262) or AZA without cyclosporine, (n = 56), with 1 year graft functional survival rates of 47, 38, and 34%, respectively. For technically successful grafts, the functional survival rates were also significantly higher (p < 0.05) in recipients treated with CSA + AZA (n = 309) than in those who received CSA without azathioprine (n = 186) or AZA without cyclosporine (n = 44), with 1 year function rates of 63, 53, and 41%, respectively. The combination of CSA and AZA did not have a detrimental effect on patient survival; for all cases, the 1 year survival rate for recipients treated with both CSA and AZA was 85%, versus 76% in those treated with CSA without azathioprine and 60% in those treated with AZA without cyclosporine (p < 0.05). Kidneys were transplanted in 609 (83%) of the 736 recipients of primary pancreas transplants in 1983-86; pancreas graft survival rates were not significantly different (p > 0.1) for recipients of simultaneous kidney transplants (n = 465) than in recipients of pancreas transplants after a kidney (n = 141) or recipients (without end stage diabetic nephropathy, non-ESDN) of pancreas transplants alone (n = 127), 46, 39, and 31% at 1 year, respectively. Patient survival rates, however, were significantly higher (p < 0.05) in recipients of pancreas transplants alone (those without ESDN and those with previous kidney transplants, 87% in both subgroups at 1 year) than in recipients of simultaneous pancreas and kidney transplants (75% at 1 year). The renal graft functional survival rate for kidneys transplanted simultaneously with a pancreas was 63% at 1 year. The results of pancreas transplantation are approaching those reported by Registries of other solid organ transplants.

This publication has 0 references indexed in Scilit: