Outcomes of pancreas retransplantation in patients with pancreas graft failure

Abstract

BackgroundPancreas retransplantation is still a controversial option after loss of a pancreatic graft. This article describes the experience of pancreas retransplantation at a high‐volume centre.MethodsThis was a retrospective observational study of all pancreas retransplantations performed in a single centre between 1997 and 2013. Pancreatic graft loss was defined by the return to insulin dependence. Risk factors for graft loss as well as patient and graft survival were analysed using logistic and time‐to‐event regression models.ResultsOf 409 pancreas transplantations undertaken, 52 (12·7 per cent) were identified as pancreas retransplantations. After a median follow‐up of 65·0 (range 0·8–174·3) months, 1‐ and 5‐year graft survival rates were 79 and 69 per cent respectively, and 1‐ and 5‐year patient survival rates were 96 and 89 per cent. During the entire follow‐up, 22 grafts (42 per cent) were lost. Patient survival was not associated with any of the donor‐ or recipient‐related factors investigated. Five‐year graft survival was better after simultaneous kidney–pancreas retransplantation than pancreas retransplantation alone: 80 per cent (16 of 20) versus 63 per cent (20 of 32) (P = 0·226). Acute rejection (odds ratio 4·49, 95 per cent c.i. 1·59 to 12·68; P = 0·005) and early surgical complications (OR 3·29, 1·09 to 9·99, P = 0·035) were identified as factors with an independent negative effect on graft survival.ConclusionPancreas retransplantation may be considered for patients whose previous graft has failed.

Challenges Associated with Pancreas and Kidney Retransplantation—A Retrospective Analysis

“…Careful donor selection is also considered a decisive criterion. For example, organs from donors with comorbidity, fatty or hardened pancreas grafts, or those with signs of trauma or ischemia should not be used [15,22]. In addition, a low pancreas donor risk index (PDRI) seems to be associated with better primary function [27].…”

“…Regarding the risk profile of recipients, it should be noted that pancreas transplantation is not absolutely necessary for survival [22]. Intensified insulin therapy, the use of insulin pumps, and islet transplantation are currently alternatives to Re-SPK.…”

“…Presently, there are numerous publications on isolated pancreas retransplantation [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25], but only a few with a small number of cases of Re-SPK after previous SPK [26][27][28].…”

Donor cardiac arrest and cardiopulmonary resuscitation: impact on outcomes after simultaneous pancreas–kidney transplantation – a retrospective study

“…The SPK transplantations were carried out according to standard techniques as previously published . Full‐size pancreas grafts were procured in a no‐touch technique after perfusion with University of Wisconsin or histidine–tryptophan–ketoglutarate solution.…”

Recipient age and outcome after pancreas transplantation: a retrospective dual‐center analysis

“…Simultaneous pancreas kidney (SPK), pancreas after kidney (PAK), or pancreas transplant alone (PTA) transplantations were carried out according to standard techniques as published before [17][18][19][20] Full-size pancreas grafts were procured in a no-touch technique after perfusion with University of Wisconsin (UW) or histidine-tryptophan-ketoglutarate (HTK) solution. Briefly, the renal artery and vein were anastomosed to the left external iliac vessels; the pancreas graft was transplanted intraperitoneally into the right middle to lower quadrant.…”