Similar Results With Solitary Pancreas Transplantation Compared to Simultaneous Pancreas-Kidney Transplantation in the New Millennium.

Abstract

The purpose of this study was to analyze our single center outcomes according to pancreas transplant (PT) category in the new millennium using standardized management protocols. Methods: We retrospectively studied 202 consecutive PTs (179 with portal-enteric drainage) in 192 patients; all patients were T and B cell negative by flow cytometry and received either r-ATG or alemtuzumab induction with tacrolimus/mycophenolate ± steroids. Unlike simultaneous pancreas-kidney (SPK), solitary PT (SPT) recipients were managed with routine peri-operative anti-coagulation and surveillance pancreas biopsies. Results: From 11/01 to 3/13, we performed 162 SPK, 35 pancreas after kidney and 5 pancreas alone (40 SPTs). Demographic characteristics were mostly comparable; however, the SPT group had younger donors (SPK mean 28±12 versus SPT 22±8 years, p=0.004), shorter pancreas cold ischemia (SPK mean 17±3 versus SPT 14±2 hours, p=0.03), fewer HLA mismatches (SPK mean 4.5±1.3 versus SPT 3.0±1.3, p<0.001), fewer black recipients (SPK 23% versus SPT 7.5%, p=0.03), but more retransplants (SPK 1.2% versus SPT 35%, p<0.001). With a mean follow-up of 5.5 years, overall patient (87% SPK versus 87.5% SPT), kidney (74% SPK versus 82.5% SPT) and pancreas graft survival (both 65%) rates were comparable. Although mortality rates were similar, mortality patterns differed as no SPT recipients died early whereas the 1-, 3-, and 5-year mortality rates following SPK transplant were 4%, 9% and 12%, respectively (p<0.05). The most common causes of pancreas graft loss were death with functioning grafts in SPK and acute/chronic rejection in SPT recipients. Rates of early thrombosis were 10% in SPK and 5% in SPT patients. Cumulative clinical acute rejection rates were similar between groups (SPK 29% versus SPT 27%, p=NS). Conclusions: In the setting of depleting antibody induction and tacrolimus-based therapy, HLA matching, careful donor and recipient selection, portal-enteric drainage, peri-operative anti-coagulation, and surveillance pancreas biopsy monitoring, similar medium-term outcomes can be achieved in SPK and SPTs in the new millennium.