Introduction: Although the overall number of pancreas transplants in combination with or after a kidney transplant have declined, the number of PTA has remained relatively stable. About 70 – 80 PTAs per year are performed in the US in patients with brittle diabetes mellitus. We studied recent improvements and outcome after PTA.

Methods: 1,417 primary PTAs from deceased donors were analyzed according to 3 eras (era1: 2001-2005; era2: 2006-2010; era3: 2011-2016). Multivariate analysis was performed to assess factors that impacted outcomes and the potential need for a subsequent kidney transplant.

Results: Over time, recipient age increased, but donor age and preservation time decreased significantly. Most recipients received induction therapy and maintenance immunosuppression with Tacrolimus and MMF. These changes resulted in significant improvement in patient and pancreas graft survival. Three-year patient survival increased from 92% in era1 to 96% in era3. Pancreas graft survival 3-years post-transplant improved from 60% in era1 to 71% in era3 (p<0.0001). While early technical failure rates did not significantly change over time and remained stable (6-7%), the immunological graft loss rate in technically successful transplants dropped significantly at 3-years from 23% in era1 to 14% in era3 (p<0.001). By multivariate analysis, the most influential factors for this decrease were older recipient age and better immunosuppression. Donor factors (age, preserv. time, HLA matching) did not show any impact which may be due to an excellent donor selection process. The different duct management and venous drainage techniques did not impact outcome.

Due to better donor and recipient selection, refinements in immunosuppression and improvement in graft outcome the rate of a subsequent kidney transplant declined significantly. This was primarily contingent on native graft function at the time of transplant. If the GFR was <40ml/min, 38% of patients received a kidney graft 4-years after the pancreas transplant; if the GFR was >60ml/min only 2% of patients required a kidney graft.

Conclusion: Our study shows that the results of PTA have significantly improved and should be considered in brittle diabetic patients before the development of advanced nephropathy. Although the risk of immunological failure has also significantly decreased, results are best in recipients > 30 years of age.

CITATION INFORMATION: Laftavi M., Gruessner A., Pankewycz O., Kaylene B., Sidharth S., Gruessner R. Pancreas Transplant Alone (PTA) Outcome is Best in Brittle Diabetic Patients without Advanced Nephropathy Am J Transplant. 2017;17 (suppl 3).

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