Pancreas transplantation in older patients is safe, but patient selection is paramount

Abstract

SUMMARYPancreas transplant outcomes have progressively improved. Despite this, some centers have continued to employ historical age limits for pancreas transplant candidates. We sought to determine the importance of chronological age in determining patient and graft survival rates after pancreas transplantation. A single-center, retrospective study of adult, deceased donor simultaneous pancreas and kidney (SPK) and solitary pancreas transplants (SP, including pancreas transplant alone and pancreas after kidney transplants) in recipients ≥ 55 years (55 + ), occurring between July 1, 1999, and June 30, 2012, was performed. Seven-hundred and forty patients underwent pancreas transplantation, of which 28 patients were 55 + . Patient survival was comparable for younger and older pancreas transplant recipients. Both non-death-censored and death-censored pancreatic graft survival rates were similar in younger and in older patients. Patients aged 45-54 and those aged 55 + had more frequent cardiovascular events than younger pancreas transplant recipients. There was no difference in renal graft survival for SPK patients when compared with diabetic kidney transplant alone recipients aged 55 years and older. Older pancreas transplant recipients had acceptable long-term patient and graft survival rates, although complications may occur. Chronological age alone should not exclude a patient for pancreas transplant candidacy.

An analysis of the association between older recipient age and outcomes after whole‐organ pancreas transplantation – a single‐centre, retrospective study

“…Scalea et al . analysed 720 recipients of whom 28 were over 55 years and found that older recipients receiving SPK had better survival than those receiving kidney alone. While there may be some evidence that the excellent glycaemic control achieved in SPK transplantation may have some survival benefit, it must be recognized that in this analysis, the recipients selected for SPK and those selected for kidney alone had different comorbidity profiles resulting in selection bias and therefore making the groups incomparable.…”

Assessing Pancreas Transplant Candidate Cardiac Disease: Preoperative Protocol Development at a Rapidly Growing Transplant Program

“…Coronary disease is a significant concern before and after pancreas transplantation [10,17,18]. Perhaps resulting from decreased surgical volumes, the true frequency of CAD amongst recipients of pancreas transplants is understudied.…”

“…Perhaps resulting from decreased surgical volumes, the true frequency of CAD amongst recipients of pancreas transplants is understudied. Knowledge of the burden of CAD in the modern era is particularly important as patients are getting older before they are referred for transplantation [5,10]. Recognizing increasing volumes at our center in the setting of an aging and increasingly co-morbid pancreas transplant population, we sought to determine how many of our pancreas transplant recipients were affected by CAD [16].…”

“…Our center has also noted a trend towards older, heavier transplant recipients [16]. Recognizing the elevated, yet unknown risk for CAD in this changing patient population, we have used a rigorous approach to cardiac testing in the pre-transplant setting [10]. Here we sought to determine, among transplanted patients, the frequency of CAD and to determine if our pre-operative testing was supported by good outcomes after transplantation.…”

Improvement in pancreas transplant evaluation and surgical volume using a multidisciplinary approach

“…[1][2][3] Further, receiving a simultaneous pancreas kidney (SPK) transplant improves life expectancy over kidney transplantation alone. 4,5 Despite this, the total number of pancreas transplants in the United States has decreased since 2006.…”