Discussion and Summary

This analysis of pancreas transplant recipient cases reported to the IPTR and UNOS, (more than 21,000), showed strikingly progressive improvement in outcome over time from 1987-2003.  Patient and pancreas graft survival rates were slightly but significantly higher in non-US compared to US cases. Most US and Non-US pancreas transplant cases were SPK, but solitary transplants have risen in recent years, especially PAK. The PAK group had the largest number of retransplants; only in the SPK group were pancreas retransplant GSRs were significantly lower (p=0.001). Overall, the 1999-2003 outcome for pancreas transplantation was excellent for patient, pancreas and kidney graft survival in all categories.

While outcomes are very good across all categories, there is still need for improvement. Late graft loss rates remain lower in SPK than PAK or PTA (mainly due to less SPK rejection loss), although the long-term outcome differences are slowly decreasing. For transplants using According to duct management, SPK outcomes are similar for BD vs. ED regardless of venous management (systemic vs. portal). In both PAK and PTA, BD GSR remains higher than ED GSR with systemic venous drainage, but with ED portal drainage, GSRs are equal to BD systemic drainage.

While cadaver pancreas transplants still show some under-utilization, the number has increased annually since the 1980’s. Kidney allocation from DD has affected SPK DD transplants, which have declined, but the number of PAK transplants has increased, possibly due to the increased use of living donor kidney transplants. Solitary transplants continue to be on the rise. Even though the current transplants are underutilized in relation to number of donors, the trend is for continuing beta-cell replacement growth, whether by islet transplant or whole organ pancreas transplantation. Beta-cell replacement should be used to its full potential as a principal procedure to aid diabetic individuals in reaching their goal of achieving insulin-independence. This can be supported by listing more candidates for solitary transplants and by improving organ allocation logistics.

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