Effect of Recipient Age on USA Primary Pancreas Transplant Outcome by Era

Pancreas transplant outcome has improved over time in recipients >45 years of age and the proportion of these recipients has increased from 9% in 1987-92 to 27% in 1999-2002 (p=0.0001).

For SPK recipients, 1-year patient survival improved from 87% in the 1987-92 era (n=169) to 93% in the 1999-2002 era (n=793) (p<0.004) and pancreas graft survival improved from 75% in the 1987-92 era to 83% in the 1999-2002 era (p=0.002). Kidney GSRs were 81% and 90% respectively (p<0.001). In the 1999-2002 era, patient survival (p=0.02) and GSRs (p>0.76) were nearly equal in recipients >45 years and younger recipients.

In the solitary groups, there were few recipients >45 in the early eras. In the PAK group, 1-year patient survival changed from 81% in the 1987-92 era (n=12) to 95% in the 1999-2002 era (n=232) (p=0.20). PAK pancreas 1-year graft survival dramatically improved from 42% in the 1987-92 era to 78% in the 1999-2002 era (p=0.01). Again, older and younger recipients had nearly equal survival rates for recipient (p=0.6) and graft (p=0.06). For PTA, 1-year patient survival has always been at least 80%; for the 1999-2002 era (n=92) it was 100% (p=0.58). PTA 1-year graft survival has markedly improved from 64% in the 1987-92 era to 84% in the 1999-2002 era. In fact, 1999-2002 patient survival for age >45 years was equivalent to younger recipients (p=0.45) and graft survival rates were higher in the >45 group (p=0.05).

Effect of Donor Age on USA Pancreas Graft Survival for 1996-2002 cases

Donor age distribution has remained fairly constant across eras, about 10% >45 years for all categories.

For 1996-2002 primary cadaver recipients, pancreas GSRs were slightly lower for those from donors >45 years of age in SPK; there was little effect of donor age on PAK or PTA GSR.

Effect of Diabetes Type on USA SPK Outcome for 1996-2002 cases

Since 1994, transplant centers reported recipients as diabetes type 1 or type 2. For 2000-01, type 2 has shown a slight increase to 6%. Of 1996-2002 cadaver SPK recipients (n=5644), only 5.1% were classified by the reporting centers as type 2 (type 1 n=5356, type 2 n=288). Mean recipient age range was 38.8+8 years for type 1 and 44.6+8 years for type 2 (p=0.001). Neither patient survival rates nor pancreas graft survival rates had statistically significant differences between type 1 and type 2 cases. For type 1, patient survival at 1 year was 95% and pancreas graft survival was 84%; for type 2, rates were 93% and 84% respectively.

Effect of Venous Vascular Management on Pancreas Outcome USA ED 1996-2002 cases

For primary cadaver pancreas transplants during 1996-2002, 65% SPK, 50% PAK, 46% PTA were enteric drained (ED). Of cases with complete records for analysis of systemic and portal venous vascular management (n=4394), about 25% (n=1091) used portal vs. systemic (n=3303). Pancreas graft survival rates at 1-year were no different for SPK or PAK portal vs. systemic ED transplants: SPK 85% portal and 84% systemic; PAK 71% portal and 73% systemic. For ED PTA, pancreas portal GSRs were slightly higher: 81% portal and 70% systemic.