Background: Improved surgical techniques, modern immunosuppressive regimens, and a better understanding of donor and recipient risk factors have led to excellent short-term graft survival after pancreas transplantation (PT). However, a proportional improvement in long-term allograft survival has not yet been achieved, for which the reasons remain unclear. The aim of our study was to identify specific causes of mortality and pancreas allograft loss after PT.
Methods: We performed a retrospective review of 271 adult patients who received PT at our institution from 01/01/1998 to 12/31/2009. Causes of death were determined from medical records, and death certificates when patients died outside our institution. Autopsy reports were reviewed when available. PT loss was defined by return to a complex insulin regimen with glycemic variability and C-peptide <200 mg/dl. The study was approved by our Institutional Review Board.
Results: Of 271 PT recipients, 67 (25%) received SPK, 128 (47%) PAK and 76 (28%) received PTA. The mean recipient age was 44±9 years, 53% were male, and 97% were Caucasian. 66 recipients died during mean follow-up of 5.9±3.5 years. Patient survival at 1, 2, 5 and 10 years posttransplant was 94%, 90%, 81%, and 66%, and was not significantly different among the three PT categories (p=0.10). The most common causes of death were infection/sepsis (24%) and cardio and cerebrovascular disease (23%). Causes of death were not different among three PT types. 111 of 288 (38.5%) grafts were lost, and 10 recipients (3.7%) lost more than one allograft. Overall graft survival at 1, 2, 5 and 10 years posttransplant was 85%, 80%, 67%, and 52%. Death with function (DWF) (49 of 111, 44%) and graft thrombosis (33 of 111, 30%) were the most common causes of graft loss. Within the first year, thrombosis was the most common cause of graft loss (29 of 46, 63%), and immunologic graft loss became the most common cause censoring for death beyond one year (15 of 28, 53%). Graft survival was higher in SPK than PTA or PAK recipients (SPK vs PAK, p=0.002; SPK vs PTA, p=0.007), most likely because of the relatively low incidence of DWF and graft loss due to immunologic factors in SPK recipients.
Conclusion: Infection and cardiovascular disease are the most common causes of mortality in PT recipients. Early thrombosis and rejection remain important causes of pancreas allograft loss.
To cite this abstract in AMA style:Kudva Y, Dong M, Parsaik A, Kremers W, Dean P, Cosio F, Prieto M, Stegall M. Systematic Study of Causes of Death and Allograft Loss in Pancreas Transplantation in the Modern Era with ATG Induction and Tacrolimus Based Triple Immunosuppression [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/systematic-study-of-causes-of-death-and-allograft-loss-in-pancreas-transplantation-in-the-modern-era-with-atg-induction-and-tacrolimus-based-triple-immunosuppression/. Accessed November 28, 2020.
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