Introduction: The number of whole organ pancreas transplants declined significantly over the past 15 years. The largest decrease was seen in pancreas after kidney (PAK) transplants. Between 2001-05 (era 1) and 2011-15 (era 2), the rate of primary PAKs declined by 74%; primary PTA, 33%; and primary SPK, 15%. Despite the decline in numbers a significant improvement in patient and pancreas graft survival was noted. The aim of this study was to identify factors for improved outcome in era 2.

Methods: In 2001-2005 (era1) 1,321 and in 2011-15 (era2 ) 354 primary deceased donor PAKs were performed. The UNOS/IPTR database was closed for analysis on 6/15/2017. Extensive univariate and multivariate analyses for recipient and donor characteristics, immunosuppressive regimens, and operative techniques were used to describe differences between eras, and impact of factors on recipient outcome.

Results:

Patient survival improved from 90% at 3 years in era 1 to 93% in era 2 (p=0.08). Table 1 shows the significant improvements in pancreas graft function by era.While the incidence of early acute rejection episodes did not change, pancreas graft function improved significantly in era 2 (p=0.0001) due to lower technical and immunological graft failure rates. The number of PAK transplant centers decreased from 124 to 88 in era 2. The number of living donor kidneys increased by 10% to 79% in era 2 (p=0.003). Over time, the recipients got significantly older, the donors younger, and the preservation time shorter. Significantly more patients in era 2 received induction therapy and combined tacrolimus/ MMF maintenance therapy. The time between kidney and pancreas transplant changed also. In era1 the time between kidney and pancreas was significantly shorter especially after a LD kidney transplant.

Conclusion: Outcome after PAK has significantly improved due to refinements in immunosuppressive protocols and better donor and recipient selection. If a living kidney donor is available, a PAK is an alternative to a SPK due to similar outcome.

CITATION INFORMATION: Gruessner A., Laftavi M., Pankewycz O., Gruessner R. Declining Number of Pancreas after Kidney Transplants Despite Significant Improvement in Outcome Am J Transplant. 2017;17 (suppl 3).

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