Pancreas Transplantation of US and Non-US Cases from 2005 to 2014 as Reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR)

Abstract

This report is an update of pancreas and kidney transplant activities in the US and non-US region in two periods, 2005-2009 and 2010-2014. The aim of the report was to analyze transplant progress and success in the US compared to non-US countries, and to compare trends between the two periods. Between 2005-2009 and 2010-2014, the number of US pancreas transplants declined by over 20%, while the overall number of pancreas transplants performed outside the US has increased. The decline in US numbers is predominantly due to the decline in primary and secondary pancreas after kidney transplants (PAK). During the time period studied, the number of PAK transplants dropped by 50%. In contrast, the number of simultaneous pancreas/kidney transplants (SPK) declined by only 10%, and the number of pancreas transplants alone (PTA) by 20%. Over 90% of pancreas transplants worldwide were performed, with a simultaneous kidney transplant and excellent results. Transplant outcomes in SPK improved significantly because of a decrease in the rates of technical and immunologic graft loss. In 2010-2014 vs. 2005-2009, US SPK transplant patient survival at 1 year post-transplant increased from 95.7% to 97.4%, pancreas graft function from 88.3% to 91.3%, and kidney function from 93.6% to 95.5%. A significant improvement was also noted in PAK transplants. One-year patient survival increased from 96.4% to 97.9% and pancreas graft function from 81.0% to 86.0%. PTA 1-year patient survival remained constant at 97%, and pancreas 1-year graft survival improved from 81.0% to 85.7%. With the decline in the number of transplants, a change towards better pancreas donor selection was observed. In solitary transplants, the donors were primarily young trauma victims, and the pancreas preservation time was relatively short. A general tendency towards transplanting older recipients was noted. In 2010-2014 vs. 2005-2009, PTA recipients 50 years of age or older accounted for 32% vs. 22%, PAK for 28% vs. 22%, and SPK for 22% vs. 20%. This may be due to a relatively lower immunologic graft loss rate, especially in solitary transplants, which historically has been high in young recipients. The number of pancreas transplants in patients with type 2 diabetes and end-stage renal disease has increased, and accounted for 9% of all SPK recipients in 2010-2014.

Exocrine drainage in vascularized pancreas transplantation in the new millennium

“…Since the inception of the International Pancreas Transplant Registry (IPTR) in 1984, data on > 48000 pancreas transplants has been captured in the ensuing 30 years [1] . There exist 3 major types of vascularized pancreas transplantation; simultaneous pancreaskidney (SPK), sequential pancreas after kidney (PAK), and pancreas transplantation alone (PTA).…”

“…In the past 3 decades, the results of SPK transplantation have been superior to solitary pancreas transplantation although the disparity in outcomes has decreased over time. In the United States, solitary pancreas transplants (PAK-17%, PTA-9%) represent the minority of activity while 74% are characterized as SPK transplants [1][2][3] .…”

“…The number of United States annual pancreas transplants reached a high of 1484 in 2004 and had dropped to < 1000 by 2014 [1][2][3] . The number of annual pancreas transplants reported to the Eurotransplant Network has similarly declined in the past decade whereas annual activity in the United Kingdom has remained relatively stable and activity elsewhere in the world has increased [1][2][3] .…”

“…The number of United States annual pancreas transplants reached a high of 1484 in 2004 and had dropped to < 1000 by 2014 [1][2][3] . The number of annual pancreas transplants reported to the Eurotransplant Network has similarly declined in the past decade whereas annual activity in the United Kingdom has remained relatively stable and activity elsewhere in the world has increased [1][2][3] . In spite of declining numbers, outcomes have continued to improve and include higher risk groups such as African-Americans, patients with a phenotype suggesting "type 2 diabetes" and solitary pancreas transplant recipients [1][2][3][4][5] .…”

“…By review of data provided by the IPTR, it is evident that the overwhelming majority of pancreas transplants involve whole organ pancreatico-duodenal grafts with either bowel (systemic-enteric) or bladder diversion of the pancreatic ductal secretions coupled with systemic venous delivery of insulin [1,2] . However, starting in 1995, a seismic change from bladder to bowel exocrine diversion transpired coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion [13,14] .…”