USA Pancreas Graft Immunological Loss

The pancreas graft immunological loss rates (rejection or recurrence of autoimmune disease) for the technically successful (TS) primary DD United States pancreas transplants 1999-2003, were analyzed for all categories. SPK rates did not differ significantly by duct management: only 2.2% at 1-year in BD and 1.7% in ED cases (Figure 28a).  The overall SPK rate has decreased steadily from 6% in the 1987-92 era to 2.2% in the 1999-2003 era. Similar results were noted for BD vs. ED in the PAK categories (Figure 28b). For PAK, the 1-year immunological loss rate for BD rate was 5.7%; the ED rate was 4.8%. For PTA, the 1-year immunological loss rates for BD were higher than for ED: the BD rate was 4.7%; the ED rate was 9.2% (Figure 28c).  The higher GSR for BD PAK was due to a lower TF rate for BD, while in PTA the higher GSR is due to lower immunological loss rate. As noted earlier in the technical failure analyses, some technical graft failures may actually be thrombosis secondary to rejection, especially in the ED solitary transplants where urine amylase cannot be used to monitor for decrease in graft function.  Historically, overall PAK and PTA immunological graft loss rates have dramatically decreased: for PAK, from 23% in the 1987-92 era to 2% in the 1999-2002 era (p=0.0001); for PTA, from 28% in the 1987-92 era to 7% in the 1999-2002 era (p=0.0001).

Figure 28a

Figure 28b

Figure 28c

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