Abstract
Theoretically, pancreas transplant alone in uremic (PTAU) patients could also be one of the options for those waiting for both pancreas and kidney grafts, but it has never been reported. There were 160 cases of pancreas transplant in this study, including 16% PTAU. The 5-year patient survival was 66.2% after PTAU, 94.5% after SPK, 95.8% after PAK, and 95.4% after PTA. Rejection of pancreas graft was significantly lower in PTAU group (3.8%), followed by 16.7% in pancreas after kidney transplant (PAK), 29.8% in simultaneous pancreas and kidney transplant (SPK) and 37.0% in pancreas transplant alone (PTA). Fasting blood sugar and serum HbA1c levels after PTAU were not significantly different from those by other subgroups. The 5-year death-censored pancreas graft survival was 100% after PTAU and PAK, and 97.0% after SPK and 77.9% after PTA. However, the 5-year death-uncensored pancreas graft survival was 67.0% after PTAU, 100% after PAK, 91.3% after SPK, and 74.0% after PTA. The superior graft survival in the PTAU group was achieved only if deaths with a functioning graft were censored. In conclusion, given the inferior patient survival outcome, PTAU is still not recommended unless SPK and PAK is not available. Although PTAU could be a treatment option for patients with diabetes complicated by end-stage renal disease (ESRD) in terms of surgical risks, endocrine function, and immunological and graft survival outcomes, modification of the organ allocation policies to prioritize SPK transplant in eligible patients should be the prime goal.
Highlights
Pancreas transplant remains the best option of treatment to achieve long-term physiological euglycemia and insulin independence for patients with labile diabetes mellitus (DM) such as type 1 DM (T1DM)
Based on the patient’s condition, pancreas transplants were classified into 4 subgroups at our institute: PTAU, pancreas transplant alone in uremic patients waiting for both pancreas and kidney transplant; simultaneous pancreas-kidney transplant (SPK), simultaneous pancreaskidney transplant; PAK, pancreas after kidney transplant; PTA, pancreas transplant alone
A total of 160 cases of pancreas transplant were included in this study, including 26 (16%) PTAU, 37 (23%) SPK, 24 PAK (15%), and 73 (46%) PTA
Summary
Pancreas transplant remains the best option of treatment to achieve long-term physiological euglycemia and insulin independence for patients with labile diabetes mellitus (DM) such as type 1 DM (T1DM). Pancreas transplant alone in uremic patients (PTAU) could be one of the options for those waiting for both pancreas and kidney grafts. For diabetic patients with uremia, SPK is undoubtedly the preferred option, and kidney transplant first in PAK is well documented choice, but how about pancreas transplant first in PTAU? The aim of this work was to assess the feasibility and justification of pancreas transplant first in the diabetic patients with uremia, PTAU group, by comparing the surgical risks and outcomes of endocrine, immunology, and pancreas graft survival between PTAU and other traditional transplant subgroups.
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