Association between the pancreas transplantation and survival of patients with diabetes: A single center experience

<div><p>Pancreas transplantation is considered a therapeutic option for patients with complicated diabetes mellitus. In this study, we compared survival rate between patients on the waiting list for pancreas transplant alone(PTA), simultaneous pancreas–kidney(SPK) transplant, and pancreas after kidney(PAK) transplant and transplant recipients. A total of 503 patients (PTA:n = 116; SPK:n = 303; PAK:n = 84) and 280 PT recipients (PTA:n = 89; SPK:n = 155; PAK:n = 36) were retrospectively analyzed at our center between February 2000 and December 2015; 11.9%(60/503) of the patients on the waiting list and 4.3%(12/280) of the PT recipients died. The overall survival rate was higher in the waiting list group for the first year (99.3% vs. 97.8%), after which it was significantly higher in PT group (p = 0.039). The overall relative risk of all-cause mortality for transplant recipients was 2.145(p = 0.285) for PTA, 0.688(p = 0.735) for PAK, however,0.361 (p = 0.012) for SPK compared with that for the waiting list patients. SPK transplant recipients had considerable higher survival benefits, despite the relatively long waiting period, especially after 1 year. In addition, PTA and PAK can also be considered as a treatment option as patient survival was not poor.</p></div

Comparison of causes of death between waiting and PT group.

<p>Comparison of causes of death between waiting and PT group.</p

Survival curves comparing the deaths of patients on the waiting list with those after pancreas transplantation.

<p>Survival curves comparing the deaths of patients on the waiting list with those after pancreas transplantation.</p

Relative risk of mortality according to transplant type.

<p>(A) Pancreas transplant alone (B) Simultaneous pancreas-kidney transplant (C) Pancreas after kidney transplant.</p

Demographics of patients on the waiting list and recipients of pancreas transplantation.

<p>Demographics of patients on the waiting list and recipients of pancreas transplantation.</p

Comparison of patients survival between waiting group and pancreas transplantation group according to transplant type.

<p>Follow-up periods were calculated from the registration to KONOS in waiting group and the pancreas transplantation in PT group.(A) Pancreas transplant alone (B) Simultaneous pancreas-kidney transplant (C) Pancreas after kidney transplant.</p

Study population according to the transplant type and mortality.

<p>Study population according to the transplant type and mortality.</p

Comparison of demographics of patients between waiting group and pancreas transplantation group according to their transplant type.

<p>(*p<0.05).</p

Long-term effects of pancreas transplant alone on nephropathy in type 1 diabetic patients with optimal renal function

<div><p>Background</p><p>Limited data are available regarding optimal selection criteria for pancreas transplant alone (PTA) to minimize aggravation of diabetic nephropathy.</p><p>Methods</p><p>A total of 87 type 1 diabetic patients were evaluated before and after PTA at a single center from January, 1999 to December, 2015, together with 87 matched non-transplanted type 1 diabetic subjects who were candidates for PTA to compare deterioration of native kidney function. A total of 163 patients (79 in the transplanted group and 84 in the nontransplanted group) were finally enrolled after excluding nine patients with estimated glomerular filtration rate less than 60 mL/min/1.73 m² and two patients with moderate proteinuria (≥ 1.5 g/day).</p><p>Results</p><p>A total of seven recipients (8.9%) had end-stage renal disease post-transplant whereas only one patient (1.2%) developed end-stage renal disease in the nontransplanted group during their follow-up period (median 12.0, range 6–96 months) (p = 0.03). Furthermore, a composite of severe renal dysfunction and end-stage renal disease (31.6% vs 2.4%) was significantly higher in the transplanted group (p < 0.001). Multivariate Cox regression analysis revealed that a higher level of tacrolimus at six months post-transplant (HR = 1.648, CI = 1.140–2.385, p = 0.008) was the only significant factor associated with end-stage renal disease.</p><p>Conclusions</p><p>There is a considerable risk for deterioration of renal function in PTA recipients post-transplant compared with non-transplant diabetic patients. With rather strict selection criteria such as preoperative proteinuria and estimated glomerular filtration rate, PTA should be considered in diabetic patients to minimize post-transplant aggravation of diabetic nephropathy.</p></div

Kaplan-Meier curves for more than 15-year (A) patient survival and (B) death-censored pancreas allograft survival according to a preoperative eGFR.

<p>Kaplan-Meier curves for more than 15-year (A) patient survival and (B) death-censored pancreas allograft survival according to a preoperative eGFR.</p