Survival After Pancreas Transplantation in Patients With Diabetes and Preserved Kidney Function

• Published in: JAMA : the journal of the American Medical Association 2003-12, Vol.290 (21), p.2817-2823
• Main Authors: Venstrom, Jeffrey M, McBride, Maureen A, Rother, Kristina I, Hirshberg, Boaz, Orchard, Trevor J, Harlan, David M
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Child; Diabetes; Diabetes Mellitus - mortality; Diabetes Mellitus - surgery; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Management. Various non-drug treatments. Langerhans islet grafts; Medical sciences; Middle Aged; Pancreas; Pancreas Transplantation - mortality; Patients; Prognosis; Proportional Hazards Models; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Transplants & implants; Waiting Lists
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.290.21.2817

CONTEXT Solitary pancreas transplantation (ie, pancreas alone or pancreas-after-kidney) for diabetes mellitus remains controversial due to procedure-associated morbidity/mortality, toxicity of immunosuppression, expense, and unproven effects on the secondary complications of diabetes. Whether transplantation offers a survival advantage over conventional therapies for diabetes is unknown. OBJECTIVE To determine the association between solitary pancreas transplantation and survival in patients with diabetes and preserved kidney function. DESIGN, SETTING, AND PATIENTS Retrospective observational cohort study conducted at 124 transplant centers in the United States, in 11 572 patients with diabetes mellitus on the waiting list for pancreas transplantation (pancreas alone, pancreas-after-kidney, or simultaneous pancreas-kidney) at the United Network for Organ Sharing/Organ Procurement and Transplantation Network between January 1, 1995, and December 31, 2000. All patients receiving a multiorgan (other than simultaneous pancreas-kidney) transplant were excluded, as were those listed for solitary pancreas transplantation who had a serum creatinine level greater than 2 mg/dL (176.8 µmol/L) at time of listing, or who ultimately received a simultaneous pancreas-kidney transplant. MAIN OUTCOME MEASURE All-cause mortality within 4 years following transplantation (or within a comparable time on the waiting list for the group not undergoing transplantation). RESULTS Overall relative risk of all-cause mortality for transplant recipients (compared with patients awaiting the same procedure) over 4 years of follow-up was 1.57 (95% confidence interval [CI], 0.98-2.53; P = .06) for pancreas transplant alone, 1.42 (95% CI, 1.03-1.94; P = .03) for pancreas-after-kidney transplant, and 0.43 (95% CI, 0.39-0.48) for simultaneous pancreas-kidney transplant. Transplant patient 1- and 4-year survival rates were 96.5% and 85.2% for pancreas transplant alone, respectively, and 95.3% and 84.5% for pancreas-after-kidney transplant, while 1- and 4-year survival rates for patients on the waiting list were 97.6% and 92.1% for pancreas transplant alone, respectively, and 97.1% and 88.1% for pancreas-after-kidney transplant. CONCLUSION From 1995-2000, survival for those with diabetes and preserved kidney function and receiving a solitary pancreas transplant was significantly worse compared with the survival of waiting-list patients receiving conventional therapy.