Systematic Study of Causes of Death and Allograft Loss After Pancreas Transplantation in the Modern Era.

Abstract

Background: The aim of the study is to identify specific causes of mortality and pancreas allograft loss of the three pancreas transplantation (PT) types in the modern era with ATG induction and tacrolimus based triple immunosuppression. Methods: We performed a retrospective review of 262 adult patients who received PT at our institution from 01/01/1998 to 12/31/2009. The causes of death and graft loss were determined by reviewing clinical and histologic information. Results:89 recipients from the cohort died during the median follow-up of 8 years (IQR 4.1 to 11.2 years). The most common causes of death were infection/sepsis (20%) and cardio/cerebrovascular disease (25 %). Among patients that died, the cause of death was not different among the three PT types (p=0.50). 133 of 279 (48%) grafts were lost, and 10 recipients (4%) lost more than one allograft. Graft losses due to death with a functioning graft (DWF)(37%) and graft thrombosis (17% early and 7% late) were the most common causes. Within the first year post PT, early thrombosis was the most common cause of all graft loss (53%). Immunologic factors became most common causes censoring for death beyond one year post PT (50%). Graft survival was higher in Simultaneous Pancreas Kidney transplantation (SPK) than that in Pancreas transplantation alone (PTA) or Pancreas after kidney transplantation (PAK) recipients, most likely because of the relative low incidence of DWF and graft loss due to immunologic factors in SPK recipients. Conclusion: PT may not change the distribution of underlying causes of death in patients with long-standing diabetes. Early thrombosis and rejection remain the main targets in our efforts to improve long term pancreas allograft survival.