Introduction: The number of whole organ pancreas transplants declined significantly over the recent 8 years. The largest decrease could be found in pancreas after kidney (PAK) transplants. Between 2002-06 and 2007-11, the rate of primary PAKs declined by 50%. With the decline in numbers a significant improvement in outcome of patient survival as well as pancreas graft function can be found. The aim of the study is to identify the factors that distinguish the 2 eras and contribute to the improved outcome of PAK transplants.

Methods: Between 1/1/2002 and 31/12/2011 2082 primary deceased donor PAK were performed; 1384 transplants in 2002-06 and 698 in 2007-11. The date of follow-up was 8/31/2012. Extensive univariate and multivariate analyses for recipient and donor characteristics, immunosuppressive regimen, and operative techniques were used to describe differences between eras, and impact of factors on patients’ outcome.

Results: Patient survival improved from 91% at 3 years in 2002-06 to 94% in 2007-11(p=0.08). Three years after pancreas transplant, 95% of 2002-06 kidneys and 96% of the 2007-11 kidneys were functioning (p=0.19). Table 1 shows the outcomes of the pancreas transplants.

While early technical failure rate and acute rejection episodes did not change, pancreas graft function was significantly better (p=0.0001). The number of PAK transplant centers decreased from 128 to 106. The number of living donor kidneys increased by 6% to now 75% in 2007-11(p=0.003). While the distribution of recipient age, duration of diabetes, time between kidney and pancreas transplant did not change over time, the average GFR at time of pancreas transplant increased significantly (p=0.005). At the same time, donor age and pancreas preservation time decreased significantly. The rate of HLA mismatches further increased. More patients received Tacrolimus and MMF without steroids as maintenance immunosuppression.

Conclusion: While the changes in immunosuppression do not seem to make the difference in outcome, better pancreas donor and patient selection may have been responsible for the improved outcome. If a living kidney donor is available, a PAK can be an alternative to a SPK with now almost equal outcome.

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