Background: Pancreas transplant volumes have been decreasing in the US since the mid-2000s. It has been conjectured that poor utilization of deceased donor pancreata (as measured by high discard rates) is a leading cause of the decreasing transplant volumes. This study by the OPTN Pancreas Transplantation Committee aims to characterize other factors influencing the decline in pancreas transplantation.

Methods: Longitudinal trends in the numbers and demographics of the national pancreas waiting lists, pancreas deceased donation, and pancreas and kidney transplantation were analyzed.

Results: The number of pancreas transplants, including pancreas after kidney (PAK), simultaneous pancreas-kidney (SPK), and pancreas transplant alone (PTA), reached it's peak around 2004 and has declined since. SPK and PTA transplants have declined slowly, but PAK transplants have sharply declined in the last decade. Simultaneously, the number of annual additions to the pancreas waiting list has been steadily decreasing since 2000 and the overall waiting list size has sharply decreased since 2006. The percent of pancreata discarded after recovery from deceased donors nationally has not changed during that time. Donors are often not having pancreata recovered due to exhausting the waiting list and donor quality. Diabetic kidney-only recipients have been mostly type II, have high BMI and are older at the time of the kidney transplant.

Conclusions: Data does not show that pancreas discard rate has influenced the decline in pancreas transplant volume. The percent of pancreata recovered and discarded has not increased over the time that pancreas transplant volume has decreased. Contributing to this trend is that fewer candidates during this time have been added to the pancreas waiting list. Over time, diabetic kidney recipients have been increasingly type II, have higher BMI and are older at the time of the kidney transplant and likely do not qualify for a pancreas transplant.

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