The Current State of Pancreas Transplantation in the USA—A Registry Report

Purpose: A successful pancreas transplantation is still the only method toprovide long-term insulin independence and provide good metabolic control forpatients with type I diabetes. Since the first pancreas transplant in 1966, thepatient and graft survival after pancreas transplantation improvedsignificantly. The aim of this report was to study the most recent outcome ofpancreas transplants. Recent Findings: Between 2011 and 2016, 5159 primary deceased donor pancreastransplants in diabetic patients were performed—4342 (84%) SPK, 399 PAK (8%),and 418 (8%) PTA. One-year (3-year) SPK patient survival reached 98% (95%), PAK97% (93%), and PTA 98% (96%). The most influential risk factor for patientsurvival in all three categories was a failed graft. In SPK, older recipientsand being on dialysis at the time of transplant also carried an increased riskto die. SPK pancreas graft function improved to 90% at 1-year and 83% at 3-yearpost-transplant; 87% and 74% for PAK; and 84% and 71% for PTA. One-year (3-year)kidney graft function for the simultaneous SPK kidney was 96% (90%). Thedifference in outcome between SPK and solitary transplants is still significantbut the gap is narrowing. A risk factor for pancreas graft failure wasespecially young recipient age, but a careful donor selection can improveoutcome. The majority of recipients received depleting antibodies for inductionfollowed by a maintenance protocol of Tacrolimus in combination with MMF.Steroids were used more often in SPK (70%) compared to solitary pancreastransplants. Summary: In summary, outcome after pancreas transplantation has significantlyimproved due to refinement in immunosuppressive protocols and better donor andrecipient selection. It can be successfully performed in patients with labilediabetes and will not only improve the quality of life of the patient but alsocan be life extending.