There is little information about incidence, indications and risk factors for late allograft pancreatectomy (PTX) in patients with ongoing immunosuppression for a functional kidney allograft.

We analyzed data on recipients of simultaneous pancreas and kidney (SPK) and pancreas after kidney (PAK) transplants at our institution between 01/1994 and 06/2013. Patients with a functional kidney allograft on immunosuppressants but documented pancreas allograft failure at least 90 days post-transplant were included in the study.

889 SPK and 133 PAK (total 1022) were included in the analyses. There were 398 pancreas failures (330 SPK and 68 PAK) later than 90 days post-transplant with a functioning kidney allograft. Of these, 55 (13.8%) PTX were performed in 53 patients. Specifically, 43 out of 330 (13 %) SPK and 12 out of 68 (17.6%) PAK underwent PTX.

Pancreas allograft failure occurred a mean of 6.24 yrs after transplant. PTX was performed a mean of 273 days after graft failure (mean of 85.3 days excluding patients undergoing PTX at the time of retransplant). We examined donor age, sex, race and BMI, as well as recipient age, sex, race BMI and history of kidney and/or pancreas rejection. None of these factors were significantly different between the PTX and non-PTX groups, and none were predictive of need for pancreatectomy.

The most common indications for late PTX were thrombosis (n=24, 43.6%), PTX at time of re-transplant (n=11, 20%), intra-abdominal abscess (n=8, 14.5%), aorto-enteric fistula (n=5, 9%), and duodenal perforation (n=4, 7%). Five (9%) grafts had features of chronic rejection. The majority of patients presented with abdominal pain, fever or nausea/vomiting.

We find multiple indications for late PTX in patients with ongoing immunosuppression, the most common being allograft vascular thrombosis. The 13.8% PTX rate is lower than the reported late nephrectomy rate of 27%, (Johnston O et. al.Am J Transplant. 2007). This is not surprising, since pancreas recipients who retain a functional kidney allograft are still fully immunosuppressed. Nonetheless, the incidence of PTX is substantial, suggesting that providers should remain vigilant about the possible need for PTX after pancreas failure.

CITATION INFORMATION: Parajuli S, Djamali A, Astor B, Sollinger H, Kaufman D, Redfield R, Odorico J, Mandelbrot D. Incidence and Indications for Pancreatectomy After Late Pancreas Allograft Failure. Am J Transplant. 2016;16 (suppl 3).

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