Abstract
Pancreas transplant rates, despite improving outcomes, have decreased over the past two decades. This is due, in part, to ageing, increasingly co-morbid pancreas transplant candidates. There is a paucity of published data regarding coronary artery disease (CAD) in this population. To inform peri-operative management strategies, we sought to understand the frequency of CAD among recipients of pancreas transplants at our center. Informed by these data, we sought to develop a standard protocol for evaluation. A retrospective review of pancreas transplants (solitary pancreas and simultaneous pancreas-kidney) was undertaken at the University of Maryland. Transplant outcomes and frequency of cardiac disease were analyzed. Current data were compared with historic controls. Over the study period, 59 patients underwent pancreas transplantation. Coronary architecture was assessed in 38 patients (64.4%). Discrete evidence of CAD was present in 28 of 39 patients (71.7%). All pancreas candidates (n = 21) who underwent left heart catheterization (LHC) demonstrated CAD (100%). No patients experienced myocardial infarction (MI) and no deaths resulted from cardiac disease in the early post-transplant period. Pancreas transplant candidates are at high risk for CAD. At a center in which pancreas transplant rates are increasing, a rigorous cardiac work up revealed that 71.7% of assessed recipients had CAD. Although asymptomatic, 6.8% required coronary artery bypass graft (CABG). Despite increasing age and co-morbid status, pancreas transplant recipients can enjoy excellent results if protocolized preoperative testing is used.
Highlights
Pancreas transplant rates have fallen from a peak of nearly 1500 in 2004 to fewer than 1000 transplants in 2018 [1,2]
Knowledge of the burden of coronary artery disease (CAD) in the modern era is important as patients are getting older before they are referred for transplantation [5,10]
Recognizing increasing volumes at our center in the setting of an aging and increasingly co-morbid pancreas transplant population, we sought to determine how many of our pancreas transplant recipients were affected by CAD [16]
Summary
Pancreas transplant rates have fallen from a peak of nearly 1500 in 2004 to fewer than 1000 transplants in 2018 [1,2]. Simultaneous pancreas and kidney (SPK) transplantation rates fell 10% annually from 2004–2011, while decreases in pancreas transplant alone (PTA) and pancreas after kidney (PAK) have been more dramatic (34% and 55%, respectively) [1,2,3]. As of 2016, only 11 centers nationally performed more than 20 pancreas transplants annually [1]. Reasons for falling transplant rates are not completely understood, but are thought to include improved diabetes management, reduced training opportunities, increased scrutiny of outcomes, and a decreasing number of surgical pancreas transplant referrals [4]. Pancreas transplant outcomes have continued to improve over the last 3 decades. For SPKs, pancreas graft survivals at 1 and 3 years have increased in the last decade from 95.2% and 90.9%, to 97.2% and 94.3%, respectively [1,5]. Pancreas transplantation improves quality of life, and extends life expectancy beyond kidney transplantation alone [6,7,8]
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