Center Volume Is Associated With Outcome After Pancreas Transplantation Within the Eurotransplant Region

Background. Outcome after surgery depends on several factors, among these, the annual volume-outcome relationship. This might also be the case in a highly complex field as pancreas transplantation. No study has investigated this relationship in a European setting. Methods. All consecutive pancreas transplantations from January 2008 until December 2013 were included. Donor-, recipient-, and transplant-related factors were analyzed for their association with patient and graft survivals. Centers were classified in equally sized groups as being low volume (= 13/year). Results. In the study period, 1276 pancreas transplantations were included. Un-adjusted 1-year patient survival was associated with center volume and was best in high volume centers, compared with medium and low volume: 96.5%, 94% and 92.3%, respectively (P = 0.017). Pancreas donor risk index (PDRI) was highest in high volume centers: 1.38 versus 1.21 in medium and 1.25 in low volume centers (P < 0.001). Pancreas graft survival at 1 year did not differ significantly between volume categories: 86%, 83.2%, and 81.6%, respectively (P = 0.114). After multivariate Cox-regression analysis, higher PDRI (hazard ratio [HR], 1.60;P < 0.001), retransplantation (HR, 1.91;P = 0.002), and higher recipient body mass index (HR, 1.04;P = 0.024) were risk factors for pancreas graft failure. High center volume was protective for graft failure (HR, 0.70;P = 0.037) compared with low center volume. Conclusion. Patient and graft survival after pancreas transplantation are superior in higher volume centers. High volume centers have good results, even though they transplant organs with the highest PDRI

Vascular response towards biodegradable sirolimus-eluting polymeric scaffolds in the porcine model

In this study, PLLA-based sirolimus-eluting polymer scaffolds and permanent bare-metal stents (316L) were implanted interventionally into both common carotid arteries (CCA) of 6 female pigs via the left common iliac artery (8F-sheath). The pigs were administered dual antiplatelet drugs peroral starting 3 days before the procedure until the end of the study. Stented CCA segments were explanted after 12 weeks, and processed for quantitative histomorphometry, and estimation of vascular inflammation and injury scores. SIR/polymer scaffolds showed a decreased residual lumen area and higher restenosis after 12 weeks (4.45 ± 2.23 mm² and 61.68 ± 22.39%) as compared to the 316L reference stent (16.53 ± 1.23 mm² and 6.65 ± 1.30%). After 12 weeks, inflammation score and vascular injury score were higher in the SIR/polymer group (1.90 ± 1.15 and 1.26 ± 0.87) compared to the 316L group (0.57 ± 0.37 and 0.83 ± 0.34)

A prospective randomized multicenter trial comparing histidine-tryptophane-ketoglutarate versus University of Wisconsin perfusion solution in clinical pancreas transplantation

We aimed to evaluate early pancreas transplant graft function after histidine-tryptophan-ketoglutarate (HTK) versus University of Wisconsin (UW) perfusion. Prospective randomized multicenter study including 68 pancreas transplantations stratified according to preservation fluid used (27 HTK vs. 41 UW). Primary endpoint was pancreas graft survival at 6 months. Serum alpha-amylase, lipase, C-peptide, HbA1C and exogenous insulin requirement were compared at several time points. Mean pancreas cold ischemia time was 10.8 +/- 3.7 (HTK) vs. 11.8 +/- 3.4 h (UW) (P = 0.247). Simultaneous pancreas-kidney transplantation was performed in 95.6% of the patients, pancreas transplantation alone in 2.9%, and pancreas after kidney transplantation in 1.5%. Six months graft survival was 85.2% (HTK) vs. 90.2% (UW) (P = 0.703). Serum amylase and lipase values did not differ between both the groups during the observation period. C-peptide levels were elevated in both the groups without significant differences at each time point. Higher exogenous insulin requirement early after transplantation in the UW group had resolved at 3 months. Six month patient survival was 96.3% (HTK) vs. 100% (UW) (P = 0.397). With a mean cold ischemia time of 10 h in this study, HTK and UW solutions appear to be equally suitable for perfusion and organ preservation in clinical pancreas transplantation