Date: Tuesday, June 14, 2016
Session Name: Concurrent Session: Clinical Pancreas Transplantation 2
Session Time: 4:30pm-6:00pm
Presentation Time: 4:30pm-4:42pm
Location: Room 210
Purpose: Pancreas transplants (tx) are increasingly performed in older patients with type 1 diabetes mellitus. This trend may be explained by the significantly higher immunologic graft loss rate younger patients. The purpose of this study was to identify risk factors for pancreas txs in younger recipients and the impact of different immunosuppressive (IS) protocols on graft outcome.
Methods: Using the IPTR/UNOS databases, we analyzed graft function and immunologic graft loss in 910 primary pancreas tx recipients under the age of 30 between 1/2005 and 12/2014. The majority of txs were performed in SPK (79%), followed by PTA (12%) and PAK (9%). Of note, in all 3 categories significantly more women were transplanted. Using uni- and multivariate models we assessed the impact of various induction and maintenance protocols on outcome adjusted for donor and recipient risk factors.
Results: In recipients <30 yrs of age, pancreas graft function at 3 years posttx was 78% in SPK, 52% in PTA and 61% in PAK. At 1 year posttx, the immunologic graft loss rates were 6% for SPK/ pancreas (35% for SPK/kidney), 19% for PTA and 11% for PAK. When adjusted for the standard donor and center specific factors the IS protocol had the highest impact on graft outcome. In SPK, the use of depleting antibodies (RR: 0.59 (0.40-0.86) and tacrolimus in combination with MMF (RR: 0.52 (0.32-83) resulted in best outcome. Additional use of non-depleting antibodies had only a minimal and steroid maintenance no impact at all. In PTA, the factor with the highest impact was the use of depleting antibodies (RR: 0.30 (0.11-0.82). The use of steroid maintenance showed an additional positive impact on graft function (RR: 0.42 (0.2-0.90). None of these IS factors reached significance in PAK.
Summary: Pancreas transplants in recipients <30 yrs of age are more prone to immunologic graft loss. It appears that potent induction therapy with depleting antibodies is strongly warranted in the SPK and PTA categories. In PTA only, long-term steroid maintenance also improved graft outcome. The combination of depleting antibodies for induction and IS tailored to the specific recipient category may further improve outcome in younger recipients.
CITATION INFORMATION: Gruessner A, Whittaker V, Narsipur S, Aggarwal V, Hubbel C, Gruessner R. Potent Induction Therapy Improves Graft Outcome in Younger Pancreas Transplant Recipients (<30 Years of Age). Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:Gruessner A, Whittaker V, Narsipur S, Aggarwal V, Hubbel C, Gruessner R. Potent Induction Therapy Improves Graft Outcome in Younger Pancreas Transplant Recipients (<30 Years of Age). [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/potent-induction-therapy-improves-graft-outcome-in-younger-pancreas-transplant-recipients-30-years-of-age/. Accessed March 5, 2021.
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