Discussion

Cox Multivariate and Logistic Regression Analyses (USA) Cox multivariate and logistic regression analyses of the USA database from 1994-1998 showed that factors have variable influence on pancreas recipient and graft survival or rejection, depending on the category (SPK, PAK PTA). For all cases, BD was associated with lower risk for pancreas graft loss than ED. MMF showed a slight positive effect in for decreased graft loss for SPK cases, while Tac showed a positive effect in SPK and PAK cases; this may be due to a center effect from one large center.

Summary of Primary Significant Relative Risk Factors

The 1994 -1998 pancreas transplant recipient cases reported to the IPTR (>4,500) were analyzed. There were no significant differences in outcomes between US cases (>4,000) and non-US cases (>500). SPK still had a higher pancreas graft survival rate than PAK and PTA, but PAK and PTA outcomes showed great improvement. The rejection rate declined so dramatically that the risk of pancreas graft loss for 1994-1998 cases was higher from technical causes than from immunological causes. Duct management technique had little effect on outcome for SPK; for PAK and PTA, pancreas graft survival rates were higher for BD than ED. Immunosuppression regimens showed minor impact on outcome for SPK cases, while PAK and PTA pancreas graft survival rates were highest in recipients who received both MMF and Tac.

Overall, the 1994-1998 outcome for pancreas transplantation was excellent for patient, pancreas, and kidney graft survival rates in all categories.