USA SPK, PAK, PTA Pancreas Graft Failure Cause 1998 - 2003

Pancreas graft failure cause for 1998-2003 US DD SPK, PAK and PTA primary transplants varied depending on the time posttransplant and the category (Figures 12a, 12b, and 12c). Technical failure includes thrombosis, infection, pancreatitis, anastomotic leak, bleed leading to removal. TF was the major cause in the first 6 months posttransplant in all categories, >60%; but after 6 months it represented only 5% SPK, 18% PAK and 25% PTA.  Immunological pancreas graft failure includes acute and chronic rejection recurrence of autoimmune isletitis with selective beta cell destruction. Acute rejection occurred from 4%-20% depending on the time period. It occurred most frequently 13-24 months posttransplant for SPK; 25-48 months posttransplant for PAK and PTA.  Chronic rejection was reported in 3%-43% as failure cause depending on the time period. For SPK, it occurred most frequently 25-48 months posttransplant; for PAK 13-24 months posttransplant; for PTA, 7-12 months posttransplant.  For purposes of this analysis, failed grafts included those defined as partial function > 6 months posttransplant, 5%-19%; these could have chronic rejection or drug-induced insufficiency.  Primary Non-Function (PNF), for purposes of this analysis, included those cases within the first 6 months who were never off insulin posttransplant. PNF represents only 3%-5% of pancreas graft failures depending on the category. Recipients with functioning pancreas grafts will eventually die (DWFG), this being the most desirable outcome with the exception of premature death. DWFG was reported as the cause more frequently in grafts that failed after vs. before 6 months: 31-39% vs. 20% SPK; 23-34% vs. 13% PAK; 10-15% vs. 6% PTA.

Figure 12a

Figure 12b

Figure 12c

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