[Frontiers in Bioscience 2, e34-40, August 1, 1997]|
PANCREAS TRANSPLANTATION: INDICATIONS, CLINICAL MANAGEMENT, AND OUTCOMES
John P. Leone, MD, PhD1, Abhinav Humar1 , Rainer W. G. Gruessner, MD, PhD2, and David E.R. Sutherland, MD3
1Transplant Fellow, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, 2Professor & Chief, Section of Pancreatic Transplantation, Department of Surgery University of Minnesota, Minneapolis, Minnesota, 3Professor & Chief, Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota
Received 6/15/97; Accepted 6/23/97; On-line 7/25/97
7. PATIENT AND GRAFT SURVIVAL
The International Pancreas Transplant Registry, housed at the University of Minnesota, collects and evaluates patient information submitted from around the world (2,3). In 1995, 1156 pancreas transplants were reported to the registry with over 1000 performed in the United States. Since 1966, the total number of cases reported are 6429 for North America, 2102 for Europe, 74 in Australia, 53 in Asia, 21 in South America, and 2 in Africa. For purposes of analysis, patients are categorized according to recipient-status, donor-status, and type of drainage procedure (Table 1). Overall, bladder drainage has the lowest technical failure rate (8%) compared to enteric (11%) and duct occlusion (23%) techniques (2,3). Furthermore, bladder drainage has improved graft survival in both the United States and Europe. In the most recent analysis, graft loss from rejection at one year for PTA and PAK patients was 6 and 9%, respectively, compared to 3 % for SPK recipients. Comparable kidney allograft survival for SPK patients and matched diabetics who received kidney allografts only (80% vs. 86%) are also seen. When data is not censored for graft loss due to technical failure or patient death with a functioning graft, over-all graft survival at 1 year now approaches 81% for SPK recipients, 71% for PAK recipients, and 64% for PTA recipients. HLA matching has no apparent impact on graft loss in SPK recipients. However, an increasing number of haplotype mismatches in PTA and PAK recipients is associated with a higher rate of graft loss in technically successful cases. Preservation data demonstrates that cold storage has minimal influence. Thus, pancreases can be safely stored at 4 ° C for 24-30 hours.
Table 1. Categories used for the international transplant registry analysis
At our institution, we recommend that uremic Type 1 diabetics consider a living related kidney first, followed by a cadaveric pancreas (25,26). This approach eliminates the stress of dialysis at the time of pancreas transplantation. For this sub-group of patients, insulin-independence at one year as reported to the registry for 1994-1995 was 79% and similar to SPK recipients (2). Overall patient survival at one year is just over 90% in all recipient categories.