Report from the International Pancreas Transplant Registry

Abstract

From December, 1966 through 1990, 3082 pancreas transplants were reported to the International Registry. A detailed analysis was performed on the 2087 transplants in the 1986-90 data base; during this time the overall one year recipient and graft functional survival rates were 89% and 62%. Univariate analyses showed graft survival rates to be significantly higher with bladder drainage than with other duct management techniques, with a simultaneous kidney transplant than without, and with preservation in UW than other solutions. Storage up to 30 hours did not adversely effect results. Graft survival rates were significantly higher in North America than Europe, a discrepancy that persisted in a Cox proportional hazard analysis that also included duct management, recipient category, HLA-DR mismatching, immunosuppression with anti-T cell agents, preservation solution and duration, and year of transplant as the other variables; three were identified to have a significant (p less than 0.05) impact on the relative risk (RR) of graft loss: 1) Recipient category, with an RR of 0.43 when placed simultaneously with a kidney; 2) Year, with an RR of 0.76 for transplants performed in 1989-90 versus 1986-88; and 3) Location, with an RR of 0.75 for transplants in North America versus Europe. The technical failure rate was significantly lower in North America than Europe, but this was not an explanation for the differences in outcome, since the same factors sorted out as significant in a Cox proportional hazard analysis of technically successful cases only. Furthermore, logistic regression analysis showed retransplantation, duct management, recipient category, preservation solution, and storage time to significantly influence the technical failure rate. The risk of technical failure was lowest for primary, bladder-drained, simultaneous pancreas/kidney, less than 12 hour UW stored grafts; year and location of transplant were not significant factors. Pancreas transplant results continue to improve and are in the range of those for other solid organs.

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

“…47 For cadaver solitary pancreas transplants, the rejection rate remained high with the immunosuppression available at the time (Minnesota antilymphocyte globulin, azathioprine, and prednisone). Although International Pancreas Transplant Registry data 42 showed that SPK transplants gave an advantage in terms of pancreas graft survival, we believed that the immunologic problems of solitary pancreas transplants could be overcome. We persisted with the philosophy that PTA was the most logical application: why wait for secondary complications?…”

“…In contrast, every other program in the world performed only or predominately SPK transplants during this period. 42 Initially, we did not have a good marker to monitor for solitary pancreas graft rejection episodes, because an elevation in the plasma glucose level is a late manifestation (as opposed to elevation of the serum creatinine level in kidney graft recipients, which is a relatively early marker of renal allograft rejection, and one that gives an immunologic advantage to SPK recipients because serum creatinine can be used as a surrogate marker to detect rejection that usually affects both organs from the same donor). Duct management techniques later solved the problem, but initially we used other tactics.…”

The Effect of Systemic Versus Portal Insulin Delivery in Pancreas Transplantation on Insulin Action and VLDL Metabolism

“…Improvements in surgical techniques and immunosuppressive drug regimens over the past 20 years have resulted in an increase in both patient and pancreas graft survival after transplantation as well as freedom from exogenous insulin administration in well over 80% of cases at 1 year posttransplantation in most centers (1,2). The surgical technique most commonly used in North America involves whole-organ transplantation with anastomosis of the duodenal segment to the bladder for drainage of the exocrine secretions and with systemic venous anastomosis to the iliac vein (KPT-S).…”

Review of Various Techniques of Pancreas Transplantation in Rat Model

“…Since the first human pancreatic transplantation (PTx) attempt by Kelly et al in 1966 [1], PTx has been applied with increasing frequency for the treatment of diabetes mellitus and has become the only accepted treatment which consistently establishes a normoglycemic, insulinindependent state [2][3][4]. Development in PTx depends on the understanding of the pathophysiologic alterations, improvement of surgical techniques, and development of more effective immunosuppressive agents, all of which are achievable by experimental research using animal models.…”