Pancreas transplantation: Current issues, unmet needs, and future perspectives

The history of vascularized pancreas transplantation spans more than 50 years and largely parallels advances in clinical immunosuppression and surgical techniques. As of December 2017, more than 56, 000 pancreas transplants were reported to the International Pancreas Transplant Registry (IPTR) including > 32, 000 from the United States and > 24, 000 from outside of the United States. Pancreas transplantation has been performed with a high and increasing level of success for 30 years. For simultaneous pancreas-kidney (SPK) transplant recipients with dual allograft function at 1 year, the conditional half-life of the pancreas graft currently averages 12-15 years. Many pancreas transplant recipients have been insulin-independent for > 10 years and some for > 20 years. In every update of the IPTR spanning 30 years, patient and graft survival rates in all three categories of pancreas transplantation have continued to improve whereas early technical and immunological graft losses have continued to decline. Recently published data have documented that since 1987, 79, 198 life-years have been “saved” by SPK transplantation (4.6 life-years per recipient) and 14, 903 life-years by solitary pancreas transplants (2.4 life-years per recipient) in the United States.