Results of Pancreas-Transplant Registry

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Abstract
From December 1966 to March 1988, 1394 pancreas transplants were reported to the International Pancreas Transplant Registry. For the 1129 cases since 1982, the overall 1-yr graft and recipient survival rates were 46 and 82%, respectively. When analyzed according to the three most common duct-management techniques, polymer injection (n = 324), intestinal drainage (n = 282), and bladder drainage (n = 462), the 1-yr function rates were 47, 45, and 54%, respectively. The graft survival rates were also similar, whether whole (n = 492) or segmental (n = 634) grafts were transplanted (47 vs. 46% at 1 yr). Graft survival rates according to preservation times were 49, 42, and 43% at 1 yr for those stored 12h (n = 89), respectively. Immunosuppressive regimens that included both cyclosporin and azathioprine were associated with significantly (P < .03) higher graft survival rates than those that included only one of the drugs, with 1-yr graft survival rates for technically successful grafts of 67, 54, and 39% for patients treated with azathioprine plus cyclosporin (n = 602), cyclosporin without azathioprine (n = 201), and azathioprine without cyclosoporin (n = 44). Pancreas-graft survival rates differed according to whether a kidney was or was not transplanted and according to the timing of the transplant: 53, 40, and 32%, respectively, at 1 yr for cases in which a simultaneous kidney was transplanted (n = 685), a kidney had previously been transplanted (n = 201), or a kidney had never been transplanted (n = 202). Patient survival rates in the three categories were 77, 88, and 90% at 1 yr. In recipients of a pancreas-only transplant or a pancreas after a kidney from a different donor, functional survival rates were higher for bladder-drained than for enteric-drained or duct-injected grafts, whereas for recipients of a simultaneous kidney, the pancreas-graft survival rates were similar for all duct-management techniques. In recipients of simultaneous pancreas-kidney transplants (n = 685), the 1-yr kidney-graft survival rate was 69%. Loss of kidney function with continuation of pancreas funtion is uncommon, whereas loss of the pancreas with continuation of kidney function is common. Overall, the results of pancreas transplantation continue to improve. In an analysis of all cases reported to the registry for 1986–1988 (n = 604), the 1-yr patient and graft survival rates were 86 and 56%, respectively.

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