Pancreas Transplant Alone Research Articles

Evolution of Pancreas Transplantation At A Single Institution-50+ Years and 2500 Transplants.

To describe the evolution of pancreas transplantation, including improved outcomes and factors associated with improved outcomes over the past 5 decades. The world's first successful pancreas transplant was performed in December 1966 at the University of Minnesota. As new modalities for diabetes treatment mature, we must carefully assess the current state of pancreas transplantation to determine its ongoing role in patient care. A single-center retrospective review of 2500 pancreas transplants was performed over >50 years in bivariate and multivariable models. Transplants were divided into 6 eras; outcomes are presented for the entire cohort and by era. All measures of patient and graft survival improved progressively through the 6 transplant eras. The overall death-censored pancreas graft half-lives were >35 years for simultaneous pancreas and kidney (SPK), 7.1 years for pancreas after kidney (PAK), and 3.3 years for pancreas transplants alone (PTA). The 10-year death-censored pancreas graft survival rate in the most recent era was 86.9% for SPK recipients, 58.2% for PAK recipients, and 47.6% for PTA. Overall, graft loss was most influenced by patient survival in SPK transplants, whereas graft loss in PAK and PTA recipients was more often due to graft failures. Predictors of improved pancreas graft survival were primary transplants, bladder drainage of exocrine secretions, younger donor age, and shorter preservation time. Pancreas outcomes have significantly improved over time through sequential, but overlapping, advances in surgical technique, immunosuppressive protocols, reduced preservation time, and the more recent reduction of immune-mediated graft loss.

Experience from 100 consecutive pancreas transplants amidst low national transplant activity: a retrospective study at a single center in Korea.

Since 1992, over 800 pancreas transplants have been performed in Korea. However, this number is significantly lower compared to the number of kidney or liver transplants. Between 2015 and July 2023, Pusan National University Yangsan Hospital conducted 100 pancreas transplants, accounting for about 20% of all transplants performed in Korea during this period. The study comprised 27 simultaneous pancreas and kidney (SPK) transplants, 23 pancreas after kidney (PAK) transplants, and 50 pancreas transplant alone (PTA) cases. Duodenoduodenostomy was the primary surgical technique employed for exocrine drainage, along with various modifications of the venous outflow anastomosis. The availability of brain-dead donors for kidney transplants was lower compared to isolated pancreas transplants. Patients undergoing SPK transplants faced significantly longer waiting times than those receiving PTA or PAK transplants. The rate of surgical complications was acceptable, with a notably low thrombotic graft failure rate of 1.0%. In the PTA group, acute rejection of the graft pancreas occurred frequently (18.0%), though this was not statistically significant (P=0.328). The pancreas transplantation survival rates were 91.0%, 78.5%, and 75.4% at 1, 5, and 9 years, respectively. The PTA group exhibited a lower graft survival rate than the SPK and PAK groups, with marginal statistical significance (P=0.059). Graft survival rates have improved over time due to advancements in surgical techniques and immunosuppressant strategies. By sharing our experiences, we aim to enhance the activity and success of pancreas transplantation in Korea.

Posttransplant Lymphoproliferative Disease Following Pancreas Transplantation: A 40 Year Single-Center Experience.

Chronic immunosuppression following pancreas transplantation carries significant risk, including posttransplant lymphoproliferative disease (PTLD). We sought to define the incidence, risk factors, and long-term outcomes of PTLD following pancreas transplantation at a single center. All adult pancreas transplants between February 1, 1983 and December 31, 2023 at the University of Minnesota were reviewed, including pancreas transplant alone (PTA), simultaneous pancreas-kidney transplants (SPK), and pancreas after kidney transplants (PAK). Among 2353 transplants, 110 cases of PTLD were identified, with an overall incidence of 4.8%. 17.3% were diagnosed within 1 year of transplant, 32.7% were diagnosed within 5 years, and 74 (67.3%) were diagnosed after 5 years. The overall 30-year incidence of PTLD did not differ by transplant type-7.4% for PTA, 14.2% for SPK, and 19.4% for PAK (p = 0.3). In multivariable analyses, older age and Epstein-Barr virus seronegativity were risk factors for PTLD, and PTLD was a risk factor for patient death. PTLD-specific mortality was 32.7%, although recipients with PTLD had similar median posttransplant survival compared to those without PTLD (14.9 year vs. 15.6 year, p = 0.9). PTLD following pancreas transplantation is associated with significant mortality. Although the incidence of PTLD has decreased over time, a high index of suspicion for PTLD following PTx should remain in EBV-negative recipients.

416 The Impact of Pancreas Transplantation on Secondary Diabetic Complications: A Systematic Review

Abstract Aim Pancreas transplantation (PT) provides diabetic cure for patients with complicated Type 1 Diabetes Mellitus (T1DM). We aimed to examine the impact of PT on secondary diabetic complications, including retinopathy, neuropathy, and cardiovascular disease. Method A database search using MedLINE for publications up to April 2023 was conducted employing MeSH terms ‘Pancreas Transplantation’ AND ‘Diabetes Mellitus, Type 1’ AND ‘Diabetic Retinopathy’ OR ‘Heart Disease’ OR ‘Cardiovascular Diseases’ OR ‘Peripheral Vascular Disease’ OR “Amputation’ OR ‘Neuropathy.” Results 223 articles were screened, with 172 excluded as per study design (total included 51). 64.7% (n=33) of studies were retrospective case control studies, 35.3% (n=18) of studies were retrospective cohort studies. A total of 5616 patients with a mean of 99.1 (SD± 262.4) simultaneous kidney transplant (SPK) patients and 48.2 (SD± 262.4) pancreas transplant alone (PTA) patients per article were studied. All articles examining diabetic retinopathy concluded that retinopathy improved or stabilized. 69% (n=11) of papers demonstrated no significant change to visual acuity. An equal number of articles (n=4) demonstrated increased peripheral nerve conduction velocity after SPK and PTA. 40% (n=2) of articles examining vibration perception studies demonstrated an increase post-transplantation. Improvements in cardiac events incidence, metabolic factors, and heart structure were seen in 79% (n=15) of cardiovascular articles. Conclusions Despite significant heterogeneity in outcome measures observed, PT provides benefits in mitigating the complication profile of T1DM. Standardised outcome measurement should be adopted to allow assessment of the impact of beta-cell replacement with the potential for objective evidence reversibility of secondary complications.

Survival Advantages of Pancreas Transplantation

The field of transplantation has provided tremendous progress to diabetic patients. One way to objectify this development is to determine the survival advantage of transplantation in the 4 diabetic recipient categories: simultaneous pancreas and kidney transplantation (SPK), pancreas after kidney transplantation (PAK), pancreas transplantation alone (PTA), and kidney transplantation alone (KTA). Over a 21-year time period, from January 1, 2000, to May 31, 2021, the IPTR/UNOS collected information about listing and transplant outcome of diabetic patients. A total of 212,049 patient records were reviewed: 89,579 recipients who underwent pancreas and/or kidney transplantation and 122,470 patients who were placed on the waiting list and are still waiting or were removed from the waitlist due to deteriorating health or death. To determine the survival advantage of pancreas transplantation, patient survival on the waiting list versus after transplantation was defined as the primary outcome. Over the 21-year time period, pancreas and/or kidney transplantation in all 4 diabetic recipient categories saved a total of 273,843 life-years. On average, 11.7 life-years per patient were saved in the SPK category, 6.4 life-years in the PTA category, 6.3 life-years in the PAK category, and 6.6 life-years in the KTA category. The survival advantage of pancreas and/or kidney transplant recipients was highly significant compared to diabetic patients still waiting for transplantation. The survival advantage was higher for patients with type 1 vs. type 2 diabetes mellitus. The significant survival advantage of PTA recipients versus patients on the waiting list justifies the argument for pre-emptive pancreas transplantation, i.e., before the development of end-stage renal disease. Given the survival advantage as evidenced in 273,843 life-years saved, pancreas transplantation should be more widely applied, and pancreas donation encouraged.

Local Postoperative Graft Inflammation in Pancreas Transplant Patients With Early Graft Thrombosis

Background. Graft thrombosis is the main cause of early graft loss following pancreas transplantation, and is more frequent in pancreas transplant alone (PTA) compared with simultaneous pancreas-kidney (SPK) recipients. Ischemia-reperfusion injury during transplantation triggers a local thromboinflammatory response. We aimed to evaluate local graft inflammation and its potential association with early graft thrombosis. Methods. In this observational study, we monitored 67 pancreas-transplanted patients using microdialysis catheters placed on the pancreatic surface during the first postoperative week. We analyzed 6 cytokines, interleukin-1 receptor antagonist (IL-1ra), IL-6, IL-8, interferon gamma-induced protein 10 (IP-10), macrophage inflammatory protein 1β (MIP-1β), IL-10, and the complement activation product complement activation product 5a (C5a) in microdialysis fluid. We compared the dynamic courses between patients with pancreas graft thrombosis and patients without early complications (event-free) and between PTA and SPK recipients. Levels of the local inflammatory markers, and plasma markers C-reactive protein, pancreas amylase, and lipase were evaluated on the day of thrombosis diagnosis compared with the first week in event-free patients. Results. IL-10 and C5a were not detectable. Patients with no early complications (n = 34) demonstrated high IL-1ra, IL-6, IL-8, IP-10, and MIP-1β concentrations immediately after surgery, which decreased to steady low levels during the first 2 postoperative days (PODs). Patients with early graft thrombosis (n = 17) demonstrated elevated IL-6 (P = 0.003) concentrations from POD 1 and elevated IL-8 (P = 0.027) concentrations from POD 2 and throughout the first postoperative week compared with patients without complications. IL-6 (P < 0.001) and IL-8 (P = 0.003) were higher on the day of thrombosis diagnosis compared with patients without early complications. No differences between PTA (n = 35) and SPK (n = 32) recipients were detected. Conclusions. Local pancreas graft inflammation was increased in patients experiencing graft thrombosis, with elevated postoperative IL-6 and IL-8 concentrations, but did not differ between PTA and SPK recipients. Investigating the relationship between the local cytokine response and the formation of graft thrombosis warrants further research.

BK polyomavirus DNAemia in pancreas transplant recipients compared to pancreas-kidney recipients.

BK polyomavirus (BKV) infection is a common complication of kidney transplantation. While BKV has been described in non-kidney transplant recipients, data are limited regarding its epidemiology and outcomes in pancreas transplant recipients. We conducted a retrospective cohort study of adults who underwent pancreas transplantation from 2010-2020. The primary outcome was BKV DNAemia. Secondary outcomes were estimated glomerular filtration rate (eGFR) reduction by 30%, eGFR<30mL/min/1.73m2 , endstage kidney disease, and pancreas allograft failure. Cox regression with time-dependent variables was utilized. Four hundred and sixty-six patients were analyzed, including 74, 46, and 346 with pancreas transplant alone (PTA), pancreas-after-kidney, or simultaneous pancreas-kidney transplants, respectively. PTA recipients experienced a lower incidence of BKV DNAemia (8.8% vs. 32.9%; p<.001) and shorter duration of DNAemia (median 28.0 vs. 84.5 days). No PTA recipients with BKV DNAemia underwent kidney biopsy or developed endstage kidney disease. Lymphopenia, non-PTA transplantation, and older age were associated with BKV DNAemia, which itself was associated with pancreas allograft failure (adjusted hazard ratio 2.14, 95% confidence interval 1.27-3.60; p=.004). Among PTA recipients, BKV DNAemia was not associated with eGFR reduction or eGFR<30mL/min/1.73m2 . BKV DNAemia was common among PTA recipients, though lower than a comparable group of pancreas-kidney recipients. However, BKV DNAemia was not associated with adverse native kidney outcomes and no PTA recipients developed endstage kidney disease. Conversely, BKV DNAemia was associated with pancreas allograft failure. Further studies are needed to estimate the rate of BKV nephropathy in this population, and further evaluate long-term kidney outcomes.

A Decade of Pancreas Transplantation—A Registry Report

Since the first pancreas transplant in 1966, over 67,000 pancreas transplants have been performed worldwide and the number is growing. While the number of transplants in the US has changed only slightly over the past decade, many countries outside the US have shown strong growth in transplant numbers. The worldwide growth in numbers is due to the increasing number of patients with type 2 diabetes mellitus receiving a pancreas transplant. Only during the COVID-19 pandemic in 2020 and 2021 did transplant numbers decline, but they started to recover in 2022. The decline was especially noted for solitary transplants. This development over time was due to excellent patient and graft survival after simultaneous pancreas and kidney transplant (SPK). Patient survival at three years was &gt;90% in SPK as well as in solitary transplants. At 3 years post-transplant, SPK pancreas graft survival was over 86% and SPK kidney graft survival over 90%. In pancreas transplants alone (PTA) and in pancreas after kidney transplants, the 3-year graft function reached 75%. The main reasons for advancement in outcome were reductions in technical failures and immunological graft losses. These improvements were due to better patient and donor selection, standardization of surgical techniques, and superior immunosuppressive protocols.

Metabolic Outcomes After Pancreas Transplant Alone From Donation After Circulatory Death Donors-The UK Transplant Registry Analysis.

Extrapolating data from early DCD (donation after circulatory death) kidney transplantation, pancreas transplants from DCD grafts were feared to have worse metabolic outcomes. Hence, we aimed to address the question of pancreas transplant alone (PTA) from DCD donors-are our concerns justified? A UK transplant registry analysis of 185 PTA performed between 2005 and 2018 was done. All early graft losses (<3months) were excluded to allow focus on the metabolic outcomes (HbA1c, weight gain and incidence of secondary diabetic macrovascular complications). The aim was to compare the metabolic outcomes, rejection rates (including the need for steroids), patient and graft survival between DBD (Donation after brainstem death) and DCD groups. After excluding early graft losses, data from 162 PTA (DBD = 114 and DCD = 48) were analyzed. Body mass index of the donor was less in DCD group (DBD = 23.40 vs. DCD = 22.25, p = 0.006) and the rest of the baseline transplant characteristics were comparable. There were no significant differences in the HbA1c, weight gain, rejection rate, and incidence of secondary diabetic macrovascular complications post-transplant between DBD and DCD recipients. The 1-, 5-, and 10-year patient and graft survival were similar in both the groups. PTA from DCD donors have equivalent metabolic outcomes and survival (patient/graft) as that of DBD donors.

PD31-08 HEPARIN THROMBOPROPHYLAXIS IN SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OBSERVATIONAL STUDIES

You have accessJournal of UrologyCME1 Apr 2023PD31-08 HEPARIN THROMBOPROPHYLAXIS IN SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION: A SYSTEMATIC REVIEW AND META-ANALYSIS OF OBSERVATIONAL STUDIES Erica Ai-Li, Kaveh Farrohki, Max Zhang, Juliano Offerni, Patrick Luke, and Alp Sener Erica Ai-LiErica Ai-Li More articles by this author , Kaveh FarrohkiKaveh Farrohki More articles by this author , Max ZhangMax Zhang More articles by this author , Juliano OfferniJuliano Offerni More articles by this author , Patrick LukePatrick Luke More articles by this author , and Alp SenerAlp Sener More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Thrombosis is a leading causes of pancreas graft loss after simultaneous pancreas kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). There remains no standardized thromboprophylaxis protocol. The aim of this systematic review and meta-analysis is to evaluate the impact of heparin thromboprophylaxis on the incidence of pancreas thrombosis, pancreas graft loss, bleeding, and secondary outcomes in SPK, PAK, and PTA. METHODS: Following PRISMA guidelines, we systematically searched BIOSIS®, PubMed®, Cochrane Library®, EMBASE®, MEDLINE®, and Web of Science® on April 21, 2021. Primary peer-reviewed studies that met inclusion criteria were included. Two methods of quantitative synthesis were performed to account for comparative and non-comparative studies. RESULTS: We included 11 studies, comprising of 1122 patients in the heparin group and 236 patients in the no-heparin group. When compared to the no-heparin control, prophylactic heparinization significantly decreased the risk of early pancreas thrombosis and pancreas loss for SPK, PAK and PTA without increasing the incidence of bleeding or acute return to the operating room. CONCLUSIONS: This study is the first to highlight that heparin thromboprophylaxis yields an approximate two-fold reduction in both pancreas thrombosis and pancreas loss for SPK, PAK and PTA. We report the dosage, frequency, and duration of heparin administration to consolidate the available evidence. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e903 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Erica Ai-Li More articles by this author Kaveh Farrohki More articles by this author Max Zhang More articles by this author Juliano Offerni More articles by this author Patrick Luke More articles by this author Alp Sener More articles by this author Expand All Advertisement PDF downloadLoading ...

An Initial Analysis of the Baseline Levels of Dd-cfDNA After Pancreas Transplantation: A Prospective Study From High-volume Centers in the United States.

One hundred eighty-one dd-cfDNA samples (n) were collected from 77 patients (N) up to 132 mo posttransplant. The median dd-cfDNA level among all subjects was 0.28% (0.13%, 0.71%). In simultaneous pancreas-kidney (SPK) transplant recipients, the median dd-cfDNA level was 0.29% (0.13%, 0.71%), and it was 0.23% (0.08%, 0.71%) in pancreas transplant alone (PTA) recipients. When isolating for when without infection or rejection, the median dd-cfDNA level was 0.28% (0.13%, 0.64%) for SPK and 0.20% (0.00%, 0.32%) for PTA. Both transplant types approached 1.0% ≤1 mo posttransplant followed by a decrease in median dd-cfDNA. During episodes of rejection or infection, median dd-cfDNA levels were greater among all transplant types. The mean dd-cfDNA level for all pancreas transplant recipients is <1.0%, consistent with the published kidney transplant rejection threshold (>1.0%), regardless of SPK or PTA. Early posttransplant dd-cfDNA levels are transiently higher than later measurements. Dd-cfDNA elevation also correlates with rejection and infection and thus is a promising biomarker for surveilling pancreas transplant dysfunction.

Heparin Thromboprophylaxis in Simultaneous Pancreas-Kidney Transplantation: A Systematic Review and Meta-Analysis of Observational Studies.

Thrombosis is a leading causes of pancreas graft loss after simultaneous pancreas kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). There remains no standardized thromboprophylaxis protocol. The aim of this systematic review and meta-analysis is to evaluate the impact of heparin thromboprophylaxis on the incidence of pancreas thrombosis, pancreas graft loss, bleeding, and secondary outcomes in SPK, PAK, and PTA. Following PRISMA guidelines, we systematically searched BIOSIS®, PubMed®, Cochrane Library®, EMBASE®, MEDLINE®, and Web of Science® on April 21, 2021. Primary peer-reviewed studies that met inclusion criteria were included. Two methods of quantitative synthesis were performed to account for comparative and non-comparative studies. We included 11 studies, comprising of 1,122 patients in the heparin group and 236 patients in the no-heparin group. When compared to the no-heparin control, prophylactic heparinization significantly decreased the risk of early pancreas thrombosis and pancreas loss for SPK, PAK and PTA without increasing the incidence of bleeding or acute return to the operating room. Heparin thromboprophylaxis yields an approximate two-fold reduction in both pancreas thrombosis and pancreas loss for SPK, PAK and PTA. We report the dosage, frequency, and duration of heparin administration to consolidate the available evidence.

Pancreas Transplantation Alone for Brittle Diabetes Mellitus

Only about 8% of all pancreas transplants for insulin-dependent diabetes mellitus are performed in the Pancreas Transplant Alone (PTA) category. PTAs are primarily performed in diabetic, non-uremic patients with unstable glucose control, hypoglycemia unawareness, and an increased risk of diabetes-related mortality, and who have failed all of the more traditional approaches to glycemic control. Tremendous, yet not widely noticed, progress in PTA outcome has been made over the past two decades. PTA is a very safe procedure with 1-and 5-year patient survival rates of 98.3% and 90.5% according to International Pancreas Transplant Registry (IPTR) data. Since the introduction of tacrolimus and mycophenolate mofetil maintenance therapy in the 1990s and the use of depleting antibody induction therapy, PTA graft survival rates at 1-and 5-years posttransplant are 87.2% and 65.0%. To avoid the need for a future kidney after pancreas (KAP) transplant due to impaired pretransplant native kidney function and the posttransplant use of calcineurin inhibitors, the estimated Glomerular Filtration Rate (eGFR) of PTA candidates should be well within the normal range and preferably &gt; 80 mL/min/1.73m². PTAs with stable, long-term function have been shown to have a positive impact on secondary complications of diabetes mellitus. Considering the significantly improved outcome results, PTA should become the pancreas transplant option of choice before the manifestation of devastating secondary complications (kidney failure, cardio-cerebrovascular events, and blindness) that require simultaneous pancreas and kidney (SPK) transplants in qualified candidates, but with higher morbidity and mortality risks. It is important for diabetologists, endocrinologists, and other health professionals involved in the care of diabetic patients to learn about these positive PTA outcome results. Despite improvements in intensive insulin therapy, insulin-delivering devices, bioartificial pancreas, and islet transplantation, a successful PTA is the only treatment option for patients with brittle diabetes that consistently restores normal glucose homeostasis long-term without exposing recipients to the risks of severe hypoglycemia and prevents, halts, or reverses the development or progression of secondary diabetes complications.

343.4: Pancreas Transplant Outcomes With No Early Graft Loss at A Single Institution

Introduction: The reported 3-month graft failure rate for pancreas allograft remains high ranging from 7-22%. We report outcomes and experience from a single institution with no technical graft loss. Method: A retrospective chart review was conducted of patients who underwent pancreas transplant +/- a kidney transplant from 2012-2021 with a maximum follow-up of five years. Information on pancreas and kidney graft failure was obtained and defined by current 2019 Organ Procurement and Transplantation Network (OPTN) criteria. Results: There were a total 74 patients included. The average age was 47.2 (+/- 9.97) with an average duration of diabetes of 22 years. 35.1% of patients were White, 40.5% Black and 24.3% other. 25% of patients identified as Hispanic. 70% of patients were male and 30% female. 65% of patients had type I diabetes and 35% type II diabetes. Most patients underwent simultaneous pancreas kidney (SPK) transplant (92%). 5.4% had pancreas transplant after kidney (PAK) and 2.7% had a pancreas transplant alone (PTA). The 3-month pancreas and kidney allograft survival was 100%. The 1-year survival for both pancreas and kidney were 97%. 5-year survival for pancreas allograft was 90.4% and 91.8% for kidney allograft. There was no pancreas graft failure due to vascular thrombosis or technical complications. Reasons for failure (n = 8) included post-transplant lymphoproliferative disorder (PTLD), vascular compromise after one year, weight gain with diagnosis of type II diabetes after transplantation for type I diabetes (n= 2), death due to other causes such as burn, graft vs. host disease, chronic obstructive pulmonary disease complications and lung cancer. The causes for kidney graft failure (n=5) included the previous deaths mentioned and PTLD. Conclusion: We report improved survival after pancreas transplantation with no early vascular thrombosis or technical complications and good pancreas and kidney allograft survival due to optimization of technique in addition to protocolized pre- and post-operative management protocol.

113-OR: The Best Insulin Delivery System Remains a Human Pancreas

Purpose: Patients referred for pancreas transplantation represent a subset of difficult to treat diabetics, who may have clinical factors preventing them from achieving a goal Hgb A1C of ≤7%. Advanced insulin delivery systems with continuous glucose monitor (CGM) have been developed to offer less invasive treatment options in this population. We wanted to see how pancreas transplant performed compared to alternative modalities. Methods: We conducted a retrospective review of pancreas transplantation at our institution from January 1, 20 through August 1, 2021. All patients were ≥18 years who underwent either simultaneous kidney pancreas (SPK) , pancreas after kidney (PAK) , or pancreas transplant alone (PTA) . Outcomes were assessed by HgbA1C level at evaluation (eval) , at transplant (pre) , between 3-5 months posttransplant (post) and the most recent (MR) (avg 62 months SD 75.4 months) . Results: 133 patients underwent pancreas transplant during the study period, 85 SPK (62%) 39 PAK (30%) and PTA (8%) . (14%) patients suffered graft loss in the first year and were excluded from analysis. Overall, 1, and 5-year pancreas graft survival was 86% and 82%. 96 (84%) had type 1 diabetes (T1D) and 18 (16%) had type 2 diabetes (T2D) . Of the 114 patients, 33 (29%) utilized CGM with or without pump (CGM) prior to transplant and had a lower Hgb A1C (%) than those without (nonCGM) (8.18 SD 1.5 vs. 8.75 SD 1.9 p=0.04) . Hgb A1C then improved for the nonCGM group during their time on the waitlist (8.75 to 8.36 SD 1.8 p=0.004) but not the CGM group (8.18 to 8.SD 1.3 p=0.24) . Post-transplant saw significant improvement in CGM pre 8.to post 5.0 (SD.6 p=2.7E-17) and MR 5.3 (SD 0.7 p=9.9E-14) and in nonCGM pre 8.4 to post 5.2 (SD 0.62 p= 2.9E-29) and MR 5.4 (SD 0.7 p= 7.3E-29) . Conclusion: Considering the clinical challenges of staying in range for difficult to treat diabetes, leading to HgbA1C goal of ≥7%, solid organ pancreas transplantation offers superior glycemic control compared to advanced insulin delivery systems with CGM. Disclosure K.R.Mccune: None. G.Dube: None. L.E.Ratner: Advisory Panel; CareDx, Immunocore, Ltd., Natera, Stock/Shareholder; Gilead Sciences, Inc., Hansa BioPharma.

Comparing Outcomes and Cost Between Pancreas Transplant and Standard of Care in Patients With Type 1 Diabetes.

Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes. We analyzed the outcome of pancreas transplant alone (PTA) versus standard of care in the United States from 2008 to 2018. We also developed an economic model to analyze the cost-effectiveness of pancreas transplant versus continuing standard of care. We used the Scientific Registry of Transplant Recipients database and analyzed PTA recipient survival. Using those results, we developed a Markov model that followed a cohort of 40-year-old patients with type 1 diabetes over a 10-year time horizon. The primary outcomes were (i) the survival benefit of a pancreas transplant, (ii) quality-adjusted life-years (QALYs), and (iii) total costs. We found no difference in survival advantage of PTA compared with standard of care (hazard ratio, 1.09; 95% confidence interval, 0.56-2.14). However, pancreas transplant ($172,823, 6.87 QALY) was cost-saving compared with standard of care ($232,897, 6.04 QALY) for type 1 diabetes. Pancreas transplantation was cost-effective in 95% of 10,000 simulations in probabilistic sensitivity analysis, using a $100,000/QALY willingness-to-pay threshold. Although there is no difference in survival for PTA compared with standard of care, PTA is a cost-saving therapy for type 1 diabetes.

Treating Type 1 Diabetes by Pancreas Transplant Alone: A Cohort Study on Actual Long-term (10 Years) Efficacy and Safety.

Physiologically regulated insulin secretion and euglycemia are achievable in type 1 diabetes (T1D) by islet or pancreas transplantation. However, pancreas transplant alone (PTA) remains a debated approach, with uncertainties on its relative benefits and risks. We determined the actual long-term (10 y) efficacy and safety of PTA in carefully characterized T1D subjects. This is a single-center, cohort study in 66 consecutive T1D subjects who received a PTA between April 2001 and December 2007, and were then all followed until 10 y since transplant. Main features evaluated were patient survival, pancreas graft function, C-peptide levels, glycemic parameters, and the function of the native kidneys. Ten-year actual patient survival was 92.4%. Optimal (insulin independence) or good (minimal insulin requirement) graft function was observed in 57.4% and 3.2% of patients, respectively. Six (9.0%) patients developed stage 5 or 4 chronic kidney disease. In the remaining individuals bearing a successful PTA, estimated glomerular filtration rate (eGFR) decline per year was -2.29 ± 2.69 mL/min/1.73 m2. Reduction of eGFR at 1 y post-PTA was higher in those with pre-PTA hyperfiltration and higher HbA1c concentrations; eGFR changes afterward significantly correlated with diabetes duration. In recipients with normoglycemia at 10 y, 74% of normoalbuminuric or microalbuminuric subjects pre-PTA remained stable, and 26% progressed toward a worse stage; conversely, in 62.5% of the macroalbuminuric individuals albuminuria severity regressed. These long-term effects of PTA on patient survival, graft function, and the native kidneys support PTA as a suitable approach to treat diabetes in selected T1D patients.

306.6: Importing Pancreata for Transplantation: An 18-year Single Center Experience

Introduction: Pancreatic Transplant (PTX) is a safe surgical procedure offered to diabetic patients with or without chronic kidney disease. With the new allocation system in the US, more pancreas offers are coming from beyond one’s donor service area (DSA), and region. Whether transplanting grafts from beyond one’s DSA or region is a safe practice is unknown. In this study, we analyzed our experience with importing pancreata according to DSA and UNOS region source and distance from the donor hospital to the transplant center, resembling the newest changes mandated by UNOS allocation policies. Methods: We analyzed primary PTXs performed between January 2000 and December 2018. Recipients of simultaneous pancreas and kidney (SPK), primary solitary pancreas (PAN) including pancreas after kidney (PAK) and pancreas transplant alone (PTA) transplants were analyzed. Two separate analyses were performed: i) based on graft origin (local, regional and national) and ii) based on nautical mile (NM) distances form the (< 250 NM, 250 and 750 NM and > 750 NM) which were retrospectively determined. Primary outcome was DC-graft survival (DC-GS), overall and stratified by transplant type and geographical source. DC-GS survival was analyzed using Kaplan-Meier analyses. All grafts were enterically drained with systemic venous drainage. Results: There were 884 PTXs; 676 underwent SPK and 208 PAN. Of these, 152 underwent PTA and 56 PAK. Donor PDRI and recipient baseline characteristics were similar between groups. Evaluating all PTX together, we observed no statistical differences in the DC-GS based on local, regional or national organ source; nor did we see a difference based on NM distance. Analyzing by graft origin (local vs regional vs national): the 5-year DC-GS rates for SPK were similar at 83% vs 83% vs 85% (p=0.50) and the 5-year DC-GS rates for PAN were 82% vs 64% vs 75% (p=0.17). The 5-year DC-GS rates were also similar across locales for both PTA (83% vs 60% vs 77%; p=0.14) and PAK (78% vs 73% vs 69%; p=0.55). Based on the NM distance from donor to transplant hospital (<250NM, 250-750NM and >750NM): the 5-year DC-GS rates for SPK were similar across distances at 83% vs 84% vs 89% (p=0.69). The 5-year DC-GS rates for PAN were not different from one another at 73% vs 72% vs 78% (p=0.96). The 5-year DC-GS rates across distances for PTA (71% vs 73% vs 81%; p=0.79) and PAK (76% vs 70% vs 67%; p=0.65) were not statistically different from one another. Conclusions: With greater sharing mandated by new UNOS allocation policies, we aim to demonstrate the utility of importing selected pancreata from non-local regions and DSAs and from > 250NM from the transplant center. This experience emphasizes the possibility of importing pancreatic grafts to increase organ utilization, increase center transplant rates and reduce waiting times for patients.

Inferior survival outcomes of pancreas transplant alone in uremic patients

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.

Pancreas transplant with enteric drainage at a single institute in Asia

This study is to assess immunological and graft survival outcomes after pancreas transplant at a single institute in Asia. Patients undergoing pancreas transplant with enteric drainage were included. Clinical data and outcomes were evaluated and compared between each subgroup. There were 165 cases of pancreas transplant, including 38 (23%) simultaneous pancreas-kidney transplant (SPK), 24 (15%) pancreas after kidney transplant (PAK), 75 (46%) pancreas transplant alone (PTA), and 28 (17%) pancreas before kidney transplant (PBK). The overall surgical complication rate was 46.1%, with highest (62.5%) in PAK and lowest (32.0%) in PTA, P=0.008. The late complications included 32.7% infection and 3.6% malignancy. Overall rejection of pancreas graft was 24.8% including 18.2% acute and 9.7% chronic rejection. Rejection was highest in PTA group (36.0%) and lowest in PBK (3.6%). There were 56 cases (33.9%) with graft loss in total, with highest graft loss rate in PTA (38.7%). The 1-year, 5-year and 10-year pancreas graft survivals for total patients were 98.0%, 87.7% and 70.9% respectively. Enteric drainage in pancreas transplant could be applied safely not only in SPK but also in other subgroups. Enteric drainage itself would not compromise the immunological and graft survival outcomes.