Introduction: Pancreas after islet (PAI) transplantation (tx) is a treatment option for patients seeking insulin independence through a whole organ transplant after a previous, failed cell transplant. Using the IPTR and UNOS databases, we studied PAI transplant outcome between 1/2004 and 12/2014.

Methods and Results: There were 47 (29 female) recipients of a failed islet tx who subsequently underwent either a pancreas tx alone (PTA, n=35), a simultaneous pancreas and kidney tx (SPK, n=12) or a pancreas after previous kidney tx (PAK, n=10). Median recipient age was 45 (range 26-57) yrs; BMI, 23 (14-32); retx insulin requirements 24 (10-100) units. Enteric drainage was used in 89%; systemic venous drainage, 83%; PRA class1 > 50% was noted in 7 (13%) recipients; PRA class 2 > 50%, in 4 (7%) recipients.

When compared to primary pancreas matched-pairs, recipient BMI and retx insulin dosages were significantly lower in the PAI group.

Graft and patient survival rates in all 3 PAI recipient categories were not statistically significant when compared to primary pancreas txs. Irrespective of the PAI recipient category, overall 1-and 3-year PAI patient survival rates were 98% and 90%; graft survival rates defined as total insulin independence were 84% and 73%.

A failed previous islet tx had no negative impact on kidney graft survival in the SPK category: it was 100% at 1- and 3-years postx and statistically not different than kidney graft survival in primary SPKs. Although PRA levels were higher after a previous islet transplant than for recipients of primary pancreas transplants, no statistically significant difference in patient and graft survival was noted. However, there was a trend (p=0.1) towards more favorable graft survival rates in the PAI group when compared to a matched-pair pancreas retx group.

Summary and Conclusion: This analysis shows that: (1) a PAI transplant is a safe procedure with low recipient mortality, a high pancreas graft function rate both short- and long-term, and excellent kidney graft outcome; (2) pancreas (and kidney) graft survival is similar between PAI and primary pancreas transplant recipients; (3) a trend towards higher pancreas graft survival rates was noted in PAI vs. pancreas retx recipients. Patients with a failed islet transplant should be informed about the possibility of a subsequent pancreas transplant with excellent outcomes in their quest for insulin independence through transplantation.

CITATION INFORMATION: Gruessner R, Ozden N, Whittaker V, Aggarwal V, Gruessner A. Pancreas After Islet Transplantation – A Successful Treatment Option After a Failed Islet Transplant. Am J Transplant. 2016;16 (suppl 3).

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