Outcomes of Pancreas Retransplantation

Rudolph, E.; Finger, Erik B.; Chandolias, Nikolaos; Kandaswamy, Raja; Sutherland, David E.R.; Dunn, Ty B.

doi:10.1097/tp.0000000000000566

Cited by 25 publications

(23 citation statements)

References 16 publications

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“…Not surprisingly graft survival was better after simultaneous kidney–pancreas retransplantation compared with single pancreas retransplantation (80 versus 63 per cent after 5 years). The less favourable outcome following single pancreas retransplantation has also been described by other groups, and is already known for primary single pancreas transplantation8, 9, 11. One suggested reason for this is that a pancreatic graft is more immunogenic than, for example, a combined kidney graft.…”

Section: Discussionmentioning

confidence: 78%

“…Even though these data have to be taken into consideration, the discrepancy between the UNOS data and the favourable outcomes published by selected high‐volume centres highlights the importance of referring patients to experienced centres8, 11, 31. Surgical experience and meticulous immunological monitoring are crucial in patients selected for retransplantation.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes of pancreas retransplantation in patients with pancreas graft failure

Gasteiger

Cardini

Göbel

et al. 2018

British Journal of Surgery

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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.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

Outcomes of pancreas retransplantation in patients with pancreas graft failure

Gasteiger

Cardini

Göbel

et al. 2018

British Journal of Surgery

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“…As patient mortality and technical failure were not increased after pancreas retransplantation in the large Minnesota cohort, pancreas retransplantation can be considered a procedure as safe as the first transplantation . However, it is important to point out that the mean recipient age in this cohort was less than 45 years.…”

Section: Discussionmentioning

confidence: 85%

“…Some studies in small cohorts (number of retransplantations: 18‐37) reported a similar rate of graft survival after pancreas retransplantation compared to the initial transplantation . However, a recent study in the large Minnesota cohort (415 retransplantations) demonstrated an increased rate of organ failure in pancreas retransplantation; a multivariate analysis revealed increasing pancreas transplant number to result in a hazard ratio of 1.78 (for second transplants) and 2.42 (for third and fourth transplants) . Also, analysis of data from the United Network for Organ Sharing (UNOS) database including 19 705 primary transplants and 1149 retransplantations came to a similar conclusion, with a graft survival rate at 5 years of 69.2% (primary transplantation) vs 14.5% (retransplantation) …”

Section: Discussionmentioning

confidence: 99%

Islet transplantation as safe and efficacious method to restore glycemic control and to avoid severe hypoglycemia after donor organ failure in pancreas transplantation

Gerber

Hochuli

Benediktsdottir

et al. 2017

Clinical Transplantation

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The aim of this study was to assess safety and efficacy of islet transplantation after initial pancreas transplantation with subsequent organ failure. Patients undergoing islet transplantation at our institution after pancreas organ failure were compared to a control group of patients with pancreas graft failure, but without islet transplantation and to a group receiving pancreas retransplantation. Ten patients underwent islet transplantation after initial pancreas transplantation failed and were followed for a median of 51 months. The primary end point of HbA1c <7.0% and freedom of severe hypoglycemia was met by nine of 10 patients after follow-up after islet transplantation and in all three patients in the pancreas retransplantation group, but by none of the patients in the group without retransplantation (n = 7). Insulin requirement was reduced by 50% after islet transplantation. Kidney function (eGFR) declined with a rate of -1.0 mL ± 1.2 mL/min/1.73 m 2 per year during follow-up after islet transplantation, which tended to be slower than in the group without retransplantation (P = .07). Islet transplantation after deceased donor pancreas transplant failure is a method that can safely improve glycemic control and reduce the incidence of severe hypoglycemia and thus establish similar glycemic control as after initial pancreas transplantation, despite the need of additional exogenous insulin. K E Y W O R D Sinsulin, islet transplantation, pancreas transplantation, type 1 diabetes mellitus

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“…Pancreas re-transplantation may offer similar graft survival to primary transplantation but in highly selected patients 13 and likewise, ITX re-transplantation may restore insulin-independence after graft dysfunction in >80% for selected patients. 14 However, recent large series demonstrated significant decrease in graft survival after second compared to primary PTX, 15,16 and similarly ITX outcomes may also be associated with dismal graft function after re-transplantation. The common pathway of autoimmune recurrence, or re-exposure to sensitized allo-antigens pose an identical potential challenge in either setting.…”

Section: Introductionmentioning

confidence: 99%

Islet-after-failed-pancreas and pancreas-after-failed islet transplantation: Two complementary rescue strategies to control diabetes

Andrès

Livingstone

Kin

et al. 2015

Islets

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(2015) Islet-after-failed-pancreas and pancreas-after-failed islet transplantation: Two complementary rescue strategies to control diabetes, Islets, 7:6, e1126036, DOI: 10.1080/19382014.2015 To link to this article: https://doi.org/10. 1080/19382014.2015 For selected patients with type 1 diabetes, b-cell replacement is the treatment of choice, either by islet transplantation (ITX) or whole pancreas transplantation (PTX). When either modality fails, current practice is to consider retransplantation, or return to exogenous insulin. We investigate outcomes with PTX after failed ITX (PAI), and ITX after failed PTX (IAP). All patients receiving PAI or IAP at a single institution were identified. Donor and recipient variables were documented, including transplant outcomes analyzed for insulin requirement and metabolic control. Five subjects were listed for PAI, and 2 received transplants. Of the 4 listed for IAP, 3 have received transplants. The mean waitlist time was 4.5 § 4.1 y for PAI and 0.35 §0 .4 y for IAP (p D 0.08). Metabolic control was excellent after PAI, with 2/2 insulin-independent. After IAP, 1/2 achieved insulin independence and good metabolic control after 2 islet infusions. The third could not receive 2 nd infusion and presented c-peptide levels < 0.1 nmol/L. Both strategies are feasible. The outcomes after PAI in our center must be offset by much longer waitlist time due to the sensitization status of these patients. Data from multicentre experience will allow more robust comparative outcomes to be made, the current observations being restricted to a limited patient set.

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Outcomes of Pancreas Retransplantation

Cited by 25 publications

References 16 publications

Outcomes of pancreas retransplantation in patients with pancreas graft failure

Outcomes of pancreas retransplantation in patients with pancreas graft failure

Islet transplantation as safe and efficacious method to restore glycemic control and to avoid severe hypoglycemia after donor organ failure in pancreas transplantation

Islet-after-failed-pancreas and pancreas-after-failed islet transplantation: Two complementary rescue strategies to control diabetes

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