In contrast to other solid organ transplants, the characteristics of long term surviving pancreas transplants have not been well described. Our objective was to measure graft half-lives through three transplant immunosuppression eras and characterize the demographic factors in transplants with > 10-year graft survival.

A retrospective review of 2,022 pancreas transplants performed in 3 standard immunosuppression eras, pre-CsA (1978-1986), CsA/Aza (1986-1993), and Tac/MMF (1997-2016) at a single institution was studied. Anti-T cell induction was used in Csa/Aza and Tac/MMF eras, but not in the first era. A subset of transplants with alemtuzumab induction was not included. Transplants were further divided by those with failure in less 10 years and those surviving more than 10 years. Standard bivariate and multivariable models were applied and survival and graft half-lives for each category were determined from Kaplan Meier estimates.

RESULTS. Graft survival at all time intervals increased markedly from the pre-CsA era to the CsA era and then incrementally in the modern Tac era. As expected, SPK transplants had the longest graft survival with a half life of more than 22 years for death censored and 1 yr contingent grafts. PAK and PTA had shorter half life. In the latter eras, there are many transplants that survived more than 10 years. Long term survivors tended to have the following characteristics: SPK transplants, older recipients, male recipients, primary transplants, bladder drained, leaner recipient, locally recovered allografts, and lower pDRI.

Pancreas graft survival continues to improve with graft half-lives more than 20 years in optimal circumstances. Such half-life determinations may help in weighing the risk/benefits in comparison to alternative therapies, especially as islet transplantation and closed-loop insulin pumps.

CITATION INFORMATION: Adamusiak A., Kandaswamy R., Dunn T., Riad S., Finger E. Improved Long-Term Outcomes of Pancreas Transplantation: Analysis of Allograft Half-Lives and Predictive Demographic Factors Am J Transplant. 2017;17 (suppl 3).

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