Summary

This analysis of pancreas transplant recipient cases reported to the IPTR and UNOS, (more than 15,000), showed dramatic progressive improvement in outcome over time from 1987-2000. There were no significant differences in outcomes between US cases (>11,000) and non-US cases (>4000). Analysis of US cases showed the improvements were in both technical failure rates (from 16% to 8%) and in immunological failure rates (SPK from >8% to 2%; PAK from >27% to 6%; PTA from 37% to 12%).

Overall, the 1996-2000 outcome for pancreas transplantation was excellent for patient, pancreas and kidney graft survival in all categories. Non-US and US pancreas transplant results were basically similar. Duct management technique had little effect on outcome for SPK; for PAK and PTA, US pancreas graft survival rates were significantly higher for BD versus ED. Immunosuppression regimens showed improved outcome for SPK cases who received anti-T cell induction therapy and CsA/MMF for maintenance immunosuppression, while PAK and PTA pancreas graft survival rates were highest in recipients who received anti-T cell agents for induction plus both MMF and Tac for maintenance immunosuppression. HLA matching, especially at the B locus, was important to PAK and PTA transplants, but not SPK outcomes.

While cadaver pancreas transplants were still under-utilized, the number has increased annually since the 1980's. Kidney allocation has affected SPK transplants, which have plateaued. However, solitary transplants continue to be on the rise. With this trend continuing as expected, the first decade of this 21st century should see pancreas transplantation helping even more diabetic individuals achieve insulin-independence.