Pancreas Transplant Registry

Abstract

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-

Impact of pancreas transplantation on diabetic secondary complications and quality of life

“…So far, only pancreatic grafting is able to restore normal metabolism for long periods [9]. Pancreatic transplantation started in many centres in the early 1980 s when cyclosporin entered the therapeutic field of organ transplantation and steadily increased to reach more than 6800 pancreas transplant recipients according to the International Pancreas Transplant Registry [10]. Also the success rates of grafting increased impressively: the 10-year pancreas graft survival rate is 76 % and that of the patients is 90 % [10].…”

Early diagnosis and treatment of pancreas allograft rejection

“…However, these achievements have been tempered by the continuing formidable challenge of the early detection and effective treatment of rejection. Rejection is the major cause of graft loss at present, accounting for about 40% of graft failures according to registry statistics [25]. The current dilemmas in pancreas transplantation are the lack of a reliable technique for the early detection of rejection and differentiating rejection from other causes of graft failure, such as pancreatitis, vascular thrombosis, and disease recurrence.…”

Gel Entrapment and Micro-Encapsulation: Methods, Applications and Engineering Principles

“…Alternatively, transplantation of islet tissue, as a whole (Sutherland and Moudry, 1987;American Diabetes Association, 1992) or as isolated islets (Hering et al, 1988;Sharp et al, 1990;Warnock et al, 1992), can provide near-normal blood glucose control and has the potential to prevent diabetic complications (Kennedy and Lyons, 1989;Lacy, 1993;Pipeleers et al, 1994). The future use of allografts does not appear hopeful because of donor scarcity and the need for recipient immunosuppression to prevent both allograft rejection and autoimmune disease recurrence (Sutherland et al, 1984;Sutherland and Moudry, 1987).…”