Introduction: While kidney transplantation in the elderly diabetic patient is an accepted treatment of the secondary complication, pancreas transplants are controversial. Many centers have an age limit of 60 years or lower for this kind of transplantation. The aim of this study was to analyze outcomes and risk factors for patients 60 years of age or older.

Methods: Between 2000 and 2015, 251 primary deceased donor pancreas transplants were reported in patient 60 years of age or older to IPTR/UNOS for the USA. The majority were SPK (61%) followed by PTA (22%) and PAK (71%). Uni- and multivariate statistical methods were used to describe outcomes and risk factors for this special group of patients.

Results: The oldest patient in this cohort was a 73 years old type 1 diabetic male recipient. Significantly more males (60%) received a pancreas transplant but no difference between the 3 transplant categories could be found. 72% of recipients received depleting and 18% non-depleting antibody therapy for induction. In 91% of all patients, Tacrolimus in combination with MMF was used for the maintenance immuno-suppression.

Overall one- and 5 year patient survival was 85% and 68%. Patient survival at one-year (and 5 year) was 86% (72%) for SPK, 93% (71.2%) for PAK, and 74% (56.3%) for PTA. The oldest recipient survived after a SPK for over 11 years and died with functioning grafts after a cardiac event. Especially critical were the first month posttransplant – cardio-cerebro complications and infections were the major causes of death. In all 3 categories, patient age and diabetes type were not risk factors for patient survival. Only a failed kidney graft in SPK could be clearly identified as a risk factor for patient survival. Over the analyzed time, patient survival increased in all 3 categories.

One and 5-year pancreas graft function was 85.7% and 70.9% for SPK, 93.0% and 71.7% for PAK, and 75.9% and 56.3% for PTA. No difference in outcome between SPK and PAK recipients was noticed. The major reason for pancreas graft loss was 'Dying with a functioning graft' in 54% of all deaths followed by pancreas graft thrombosis in 17% of all cases. All recipient received relatively good donors so that no statistical significant risk factors could be determined.

Conclusion: After a careful work up, pancreas transplants in elderly patients can be successfully performed and will not only improve the quality of life of the patient but also can be life extending.

CITATION INFORMATION: Gruessner A., Laftavi M., Pankewycz O., Gruessner R. Pancreas Transplant in the Elderly Patient – Should It Be Done? Am J Transplant. 2017;17 (suppl 3).

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