Background: The number of pancreas transplants performed in the United States peaked in 2004 at 1,483. Since then, pancreas transplant numbers have significantly decreased. Between 2004 and 2015, the number of total pancreas transplants fell by 36%: SPKs fell by 22% but the decrease was most in PAKs at 81%. In 2004, PAKs represented 30% of all pancreas transplants whereas in 2015 they constituted only 10%. The decrease in PAKs was accompanied by a 56% decline in the number of transplant centers performing PAKs. Purpose: We studied 1 and 3-yr patient and graft survival rates after PAK, hypothesizing that the downward trend in PAK numbers reflected a decline in clinical outcome. Methods: From 1/02 to 12/15, information on 2,324 primary PAKs was reported to the International Pancreas Transplant Registry (IPTR). Uni and multivariate analyses was used to determine clinical outcomes after PAK comparing 2 eras (era 1: 2002-08 vs era 2: 2009-15). Results: The 1 and 3-yr patient and pancreas graft survival after PAK improved significantly from 96.0% and 78.7% in era 1 to 97.3% and 84.7% in era 2, respectively. Factors associated with improved outcomes were: an increase in previous living donor kidney transplants (70% vs 78%); decrease in median preservation times (13 vs 10hrs.); an increase in T-cell depleting induction therapy (66% vs 79%). PAK outcomes improved despite transplanting higher risk groups: older recipients (median age, 42 vs 43 yr.), African Americans (7.8% vs 9.6%), patients with cPRA > 20% (6.9% vs 16.4%) and use of enteric duct drainage (81.2% vs 94.8%). Recipients >60 yrs had a higher 1-year graft survival than those 30-45 (96.5% vs 81.9%). Early pancreas graft loss (<3 mths) due to technical failure decreased from 9.1% in era 1 to 7.6% in era 2 (p=0.04); 1 yr immunological loss fell from 7.1% to 4.3% (p=0.003). Summary and Conclusions: These results highlight the paradox in PAK where better results have been accompanied by fewer transplants. Advances in surgical, medical and immunological care have led to significant improvements in short and long-term outcomes. Based on these IPTR results, PAK should be promoted in more training centers for a broader range of diabetic kidney transplant recipients in order to provide for optimal blood glucose control, an insulin-free life and prevention of diabetic complications.

CITATION INFORMATION: Pankewycz O, Gruessner A, Laftavi M, Whittaker V, Aggarwal V, Gruessner R. The Paradox in Pancreas After Kidney Transplantation (PAK): Better Results but Fewer Transplants Despite an Increase in High-Risk Patients. Am J Transplant. 2017;17 (suppl 3).

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