REGISTRY REPORT ON PANCREAS RETRANSPLANTATION: LOWER INCIDENCE OF REJECTION IN THE TACROLIMUS ERA.

Abstract

688 Introduction: Between 10/01/87 and 11/30/97, 5742 cadaver pancreas (Pa) transplants (Txs) with complete information on immunosuppression therapy were reported to the International Pa Tx Registry (IPTR) and the United Network for Organ Sharing (UNOS). Of these, 3.8% were Pa reTxs. Outcome of Pa reTxs has not been studied in detail since the introduction of tacrolimus (as a substitute for cyclosporine) and mycophenolate mofetil (as a substitute for azathioprine). Patients. Of 209 Pa reTxs, 115 (56%) were rePa after kidney Txs[rePAK], 47 (22%) were rePaTxs alone [rePTA], and 47 (22%) re-simultaneous Pa-kidney Tx [reSPK]. RePAK accounted for 25% of all PAK, reSPK for only 1% of all SPK. Mainstay immunosuppressants were cyclosporine (1987-93) and, more recently, tacrolimus (94-97). Results. Pa graft survival for both primary and reTxs has significantly improved over time. One year graft survival rates for rePAK increased from 59% (1987-89) to 67% (1994-97); for rePTA, from 50% to 71%; for reSPK, from 50% to 84% (Table).The rate of technical failures of reTxs compared with primary Txs was not different for rePAK, but was higher for rePTA and reSPK. According to a univariate analysis, graft loss from rejection decreased significantly over time. One-year graft loss from rejection for rePAK decreased from 34% to 8%; for rePTA, from 39% to 20%; for reSPK, from 12% to 5%. According to a multivariate analysis, the most important risk factor for patient survival after reTxs was recipient age (risk of death increased by a factor of 3 for each 20-year increment). The most important risk factors for graft survival after reTxs were recipient and donor age (10-year increments) and poor HLA matching (particularly for rePAK and rePTA). Conclusions: 1. Graft survival for rePAK, rePTA, and reSPK improved significantly with the use of tacrolimus; in reSPK, with the use of MMF. 2. Graft loss from rejection was significantly higher in enteric versus bladder drained rePAK and rePTA (but not reSPK). 3. Good HLA matching (≥3 antigens) for rePAK and rePTA and the use of tacrolimus for rePAK, rePTA, and reSPK significantly decreased the risk of graft loss from rejection.