*Purpose: Type 1 Diabetes (T1D) is associated with increased fracture risk. Solid organ transplant recipients are at high risk for fracture but limited data are available regarding bone outcomes after Pancreas transplantation alone (PTA) for T1D. We studied incidence of fracture and bone mineral density (BMD) change after PTA in T1D patients followed for a maximum period of 10 years after the procedure.

*Methods: In this retrospective study, we evaluated 112 T1D recipients of first PTA between 04/01/1998 and 08/31/2018 at Mayo Clinic, Rochester. Fracture and BMD Data were collected at baseline and for a maximum period of 10 year after PTA whichever occurred first. Data were gathered until primary non-function due to early thrombosis, re-transplantation, or complete loss of c-peptide (less than 0.1ng/ml) along with other risk factors for fracture such as celiac, thyroid disease and bisphosphonate use during the period.

*Results: Out of 112 patients, a total of 9 patients had primary non function of the PTA within 24 to 36 hours due to thrombosis and were excluded and hence, we followed 103 patients with baseline demographics age 42.7 ± 10 years, F/M 67/36, BMI 26 ± 4.9 (Kg/m²), HbA1c 9.1 ± 2.3 (%), c-peptide 0.09 ± 0.03 ng/ml and T1D for 27 ± 11 years. Among 103 patients, 10 patients experienced 13 discrete pre-transplant fracture events (8 had 1 fracture event). Post PTA, 25 patients experienced 40 fracture events (17 had 1 fracture event) with six (24%) patients experiencing vertebral fracture as their first fracture. Two of these 25 patients had history of fracture prior to PTA. Patients with fracture are older at PTA (46.5 years old vs. 41.5 years old in those without fracture, p=0.036) and have a higher pre-transplant BMI (28.0 Kg/m² vs 25.4 Kg/m², p=0.019). Analysis of risk factors to predict time to fracture revealed that age was significantly related to risk of fracture (HR=1.07 [1.04, 1.11]; P value less than 0.001). Rate of fractures per 100 person-years was 4.2. At baseline 46 patients had BMD available irrespective of fracture and 5 out of 10 pre-transplant fracture patients had BMD available. Change in BMD was significant at lumbar spine (p =0.033) whereas change in T-score was significant at right femoral neck (p= 0.047) and right total hip (p =0.023) in patients with fractures. Using an ANCOVA model, after adjusting for age and sex in patients with fracture, BMD at left femoral neck and lumbar spine declined (p= 0.0394 and p =0.0216) more than patients without fracture. Decrease in T-score at femoral neck, total hip, and lumbar spine was more than in patients without fracture. Bisphosphonate use at baseline, celiac and thyroid disease prior to fractures did not increase risk.

*Conclusions: Patients with T1D that receive PTA are at significant risk for fragility fracture prior to PTA and experience significant risk of fragility fracture post PTA with older age and higher BMI being risk factors.

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