Background: Pancreas transplant (PTX) improves quality of life and survival for patients irrespective of pre-PTX c-peptide. Little consideration has been afforded to BK nephropathy (BKN) in benefit analyses after PTX. Our objectives were to examine determinants of outcomes and complication in patients with DM1 and DM2 after PTX.

Methods: Using a 13-yr retrospective longitudinal cohort of pancreas transplant recipients, we examined demographic and transplant factors, complications and outcomes after in patients with non-detectable pre-PTX c-peptide (DM1) and patients with detectable pre-PTX c-peptide (DM2).

Results: Mean follow-up was 4.2 years. Of 214 consecutive PTX, 112 (91 simultaneous PTX (SPK), 19 PTX after kidney (PAK), 2 PTX alone (PTA)) had pre-PTX c-peptide analyzed including 63 DM1 and 49 DM2. There were no differences between cohorts with respect to years of DM (mean 26 yr), type of PTX, age, weight, BMI, PRA, pre-PTX insulin use or HcA1c. DM1 had more females (p=0.048), more Black recipients and more re-transplants. There were no differences in donor factors or post-PTX factors (c-peptide after 2yrs, mean serum glucoses, mean follow-up HgA1Cs; patients with DM2 had more early acute post-surgical pancreatitis (p=0.036). In terms of clinical outcomes, there were no differences in post-PTX surgical, medical or infectious complications. However, DM2 patients had significantly higher rates of BKN (p=0.006). There were no differences in outcomes between cohorts for acute rejection, graft loss or death.

Conclusions: This large-scale analysis confirms that PTX can be performed with excellent and equivalent outcomes in patients with DM1 and 2; however, interestingly, patients with DM2 are more likely to have post-PTX pancreatitis and BKN. Future research is needed to determine the etiologies and methods to prevent these post-transplant issues.

« Back to 2013 American Transplant Congress