Introduction: The number of pancreas transplants (PTx) nationwide is declining, raising concern that some centers may experience low transplant volume; low volume has been associated with increased risk of graft failure (GF) for other solid organs. To examine this issue in pancreas programs, we studied two cohorts of simultaneous kidney-PTx (SPK), PTx alone (PTA), and PTx after kidney (PAK) transplant recipients who underwent transplant 7/1/2005-6/30-2010 and were followed for 1-yr post-tx, or 1/1/2003-12/31/2007 and followed for 3 yrs. For each recipient, we analyzed time since previous PTx performed at that center, of any type (TS-PTx) or procedure-specific (TS-SPK, TS-PAK, TS-PTA). Adjusted results are based on pancreas models for program-specific reports created by SRTR.

Results: Times between PTx within center overall and procedure-specific for the 1-year cohort are described in Table 1.

The effect of time since last PTx was found to be procedure-specific: overall TS-PTx was not associated with GF. Risk of adjusted PAK GF increased with longer TS-PAK (HR=1.02/month, p=0.05), as did risk of adjusted PTA GF with longer TS-PTA (HR=1.03/month, p=0.001). Both effects gained significance after adjusting for case-mix (Figure1)

Risk of pancreas allograft failure by months since last PTx of that type within center.

There was no relationship between SPK pancreas GF and TS-SPK. Results were similar in the 3-year follow-up cohort, though the hazard did not significantly increase until 8 months and 5 months since PAK and PTA, respectively.

Conclusion: Increased time since previous PAK and PTA was associated with worse pancreas allograft survival for the respective type of PTx. Increased time since previous SPK was not associated with worse pancreas allograft survival. Outcomes of PAK and PTA are more likely to be influenced by declining number of PTx nationwide.

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