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 less than 6 h (n = 694), 6-12 h (n = 237), and greater than 12 h (n = 89), respectively. Immunosuppressive regimens that included both cyclosporin and azathioprine were associated with significantly (P less than .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 cyclosporin (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).(ABSTRACT TRUNCATED AT 250 WORDS)
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 1year). Functional survival rates according to duration of preservation for grafts stored <6 h (n = 460), 6-12 h (n = 146) and 212 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 sig-
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