Lessons learned from more than 1,000 pancreas transplants at a single institution

To determine outcome in diabetic pancreas transplant recipients according to risk factors and the surgical techniques and immunosuppressive protocols that evolved during a 33-year period at a single institution. Insulin-dependent diabetes mellitus is associated with a high incidence of management pr...

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Bibliographic Details
Published in:Annals of surgery 2001-04, Vol.233 (4), p.463-501
Main Authors: SUTHERLAND, David E. R, GRUESSNER, Rainer W. G, GRUESSNER, Angelika C, NAJARIAN, John S, DUNN, David L, MATAS, Arthur J, HUMAR, Abhinav, KANDASWAMY, Raja, MAUER, S. Michael, KENNEDY, William R, GOETZ, Frederick C, ROBERTSON, R. Paul
Format: Article
Language:English
Subjects:
Adolescent
Adult
Biological and medical sciences
Cadaver
Child
Diabetes Mellitus, Type 1 - surgery
Female
Graft Rejection - epidemiology
Graft Survival
Humans
Immunosuppression - methods
Immunosuppressive Agents - therapeutic use
Kidney Transplantation - statistics & numerical data
Liver, biliary tract, pancreas, portal circulation, spleen
Living Donors
Logistic Models
Male
Medical sciences
Middle Aged
Outcome Assessment (Health Care)
Pancreas Transplantation - statistics & numerical data
Proportional Hazards Models
Retrospective Studies
Review
Risk Factors
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Treatment Outcome
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Summary:To determine outcome in diabetic pancreas transplant recipients according to risk factors and the surgical techniques and immunosuppressive protocols that evolved during a 33-year period at a single institution. Insulin-dependent diabetes mellitus is associated with a high incidence of management problems and secondary complications. Clinical pancreas transplantation began at the University of Minnesota in 1966, initially with a high failure rate, but outcome improved in parallel with other organ transplants. The authors retrospectively analyzed the factors associated with the increased success rate of pancreas transplants. From December 16, 1966, to March 31, 2000, the authors performed 1,194 pancreas transplants (111 from living donors; 191 retransplants): 498 simultaneous pancreas-kidney (SPK) and 1 simultaneous pancreas-liver transplant; 404 pancreas after kidney (PAK) transplants; and 291 pancreas transplants alone (PTA). The analyses were divided into five eras: era 0, 1966 to 1973 (n = 14), historical; era 1, 1978 to 1986 (n = 148), transition to cyclosporine for immunosuppression, multiple duct management techniques, and only solitary (PAK and PTA) transplants; era 2, 1986 to 1994 (n = 461), all categories (SPK, PAK, and PTA), predominantly bladder drainage for graft duct management, and primarily triple therapy (cyclosporine, azathioprine, and prednisone) for maintenance immunosuppression; era 3, 1994 to 1998 (n = 286), tacrolimus and mycophenolate mofetil used; and era 4, 1998 to 2000 (n = 275), use of daclizumab for induction immunosuppression, primarily enteric drainage for SPK transplants, pretransplant immunosuppression in candidates awaiting PTA. Patient and primary cadaver pancreas graft functional (insulin-independence) survival rates at 1 year by category and era were as follows: SPK, era 2 (n = 214) versus eras 3 and 4 combined (n = 212), 85% and 64% versus 92% and 79%, respectively; PAK, era 1 (n = 36) versus 2 (n = 61) versus 3 (n = 84) versus 4 (n = 92), 86% and 17%, 98% and 59%, 98% and 76%, and 98% and 81%, respectively; in PTA, era 1 (n = 36) versus 2 (n = 72) versus 3 (n = 30) versus 4 (n = 40), 77% and 31%, 99% and 50%, 90% and 67%, and 100% and 88%, respectively. In eras 3 and 4 combined for primary cadaver SPK transplants, pancreas graft survival rates were significantly higher with bladder drainage (n = 136) than enteric drainage (n = 70), 82% versus 74% at 1 year (P =.03). Increasing recipient age had an adverse effect on out
ISSN:0003-4932
1528-1140
DOI:10.1097/00000658-200104000-00003