A 10-Year Experience with 290 Pancreas Transplants at a Single Institution

Abstract

Since our report at the 1984 American Surgical Association meeting of 100 pancreas transplants from 1966 through 1983, another 190 have been performed. The current series, begun in 1978, now numbers 276 cases, and includes 133 nonuremic recipients of pancreas transplants alone (PTA), 46 simultaneous pancreas/kidney transplants (SPK), and 97 pancreas tranplants after a kidney transplant (PAK). Duct management techniques used were free intraperitoneal drainage in 44 cases, duct occlusion in 44, enteric drainage in 89, and bladder drainage in 128. The 1-year patient and graft survival rates in the entire cohort of 276 were 91% and 42%. One-year patient survival rates were 88% in the first 100, 91% in the second 100, and 92% in the last 76 cases; corresponding 1-year graft survival rates were 28%, 47%, and 56% (p less than 0.05). A prospective comparison of bladder drainage (n = 82) versus enteric drainage (n = 46) in PAK/PTA cases since November 1, 1984 favored bladder drainage (1-year graft survival rates of 52% vs. 41%) because of urinary amylase monitoring. The best results were in recipients of primary SPK bladder-drained transplants (n = 39), with a 1-year pancreas graft survival rate of 75%, kidney graft survival rate of 80%, and patient survival rate of 95%. Logistic regression analysis, with 1-year graft function as the independent variable, showed significant (p less than 0.05) predictors of success (odds ratio) to be technique: bladder drainage (5.8) versus enteric drainage (2.5) versus duct injection (1.0); category: SPK (6.0) versus PAK from same donor (3.2) versus PAK from different donor (1.2) versus PTA (1.0); and donor HLA DR mismatch: 0 (5.0) versus 1 (2.5) versus 2 (1.0) antigens. On April 1, 1989, 90 patients had functioning grafts (60 euglycemic and insulin-free for more than 1 year, 10 for 5 to 10 years); these, along with 24 others whose grafts functioned for 1 to 6 years before failing, are part of an expanding cohort in whom the influence of inducing a euglycemic state on pre-existing secondary complications of diabetes is being studied. Only preliminary data is available. In regard to neuropathy, at more than 1 year after transplant in patients with functioning grafts, conduction velocities in some nerves were increased over baseline. In regard to retinopathy, deterioration in grade occurred in approximately 30% of the recipients by 3 years, whether the graft functioned continuously or failed early, but thereafter retinopathy in the patients with functioning grafts remained stable.(ABSTRACT TRUNCATED AT 400 WORDS)

Pancreas transplant alone has beneficial effects on retinopathy in type 1 diabetic patients

“…However, many patients still progress to more severe lesions despite improvements in glucose control [4]. After blood glucose normalisation subsequent to simultaneous pancreas-kidney transplantation, a few groups (but not all) observed amelioration of diabetes ocular complications [6][7][8][9][10][11][12][13][14], but it cannot be ruled out that the attendant cure of uraemia might have played an important role [25]. Therefore, studying normoglycaemic pancreas-alone recipients is possibly a better way to assess the effects of normoglycaemia on diabetes complications.…”

“…Lately, the effects of combined pancreas-kidney transplantation on diabetic retinopathy have been described, and conflicting results reported [6][7][8][9][10][11][12][13][14]. Some work showed no significant change or even progression in retinal complications following combined pancreas-kidney transplantation [6][7][8][9].…”

“…Some work showed no significant change or even progression in retinal complications following combined pancreas-kidney transplantation [6][7][8][9]. In addition, an increased prevalence of posttransplant cataract has also been observed [15].…”

Pancreas Transplantation for Patients With Diabetes Mellitus

“…Three-year patient survival rates from three transplantation programs were reported to be 85-90% (4,12,34). The most recent survival rates are similar to those of kidney-only transplants in the general population (36). Over 90% of pancreas transplants have been conducted simultaneously or after a kidney transplant in patients who, therefore, already were obligated to immunosuppressive therapy.…”

Pancreas Transplantation for Patients With Diabetes Mellitus

“…In com-bined kidney-pancreas transplants, the risk is small enough so that such surgery can be considered as an alternative to dialysis and continued insulin therapy in many uremic diabetic patients. However, uremic recipients of kidney-pancreas transplants have a higher renal rejection episode rate and longer hospitalization than recipients of kidney-only transplants (36).…”