In the past decade, the annual number of pancreas transplants (PTxs) in the US has steadily declined coincident with increasing numbers of PTxs performed outside of the US. Methods: We retrospectively reviewed data from the International Pancreas Transplant Registry (IPTR) to identify and track trends pursuant to the scope of PTx in the US. Results: As of 12/14, >48,000 PTxs were reported to the IPTR including >29,000 from the US. The total annual number of US PTxs steadily increased until 2004 (peaking at 1484) but has since declined substantially in the past decade with only 954 PTxs performed in 2014, which is the lowest total since 1994. Since 2004, the overall number of simultaneous pancreas-kidney (SPK) transplants declined by 10% whereas decreases in PTx after kidney (PAK) and PTxs alone (PTA) were 55% and 34%, respectively. Paradoxically, these changes occurred in the setting of improvements in graft and patient survival outcomes and transplanting higher risk patients. PTx is now associated with an extremely low mortality rate, ranging from 3-4% at 1 year to <6% at 3 years in all 3 PTx categories. At 3 years, graft survival (insulin-free) rates are 83% for SPK, 76% for PAK, and 65% for PTA recipients. The number of active US PTx centers has decreased from 132 to 114; 11 centers currently perform ≥20 PTxs per year and nearly half perform <5 PTxs annually. Only 50% of centers perform PAK and 25% PTAs. 14 centers in North America are currently certified for PTx fellowship training (minimum of 20/yr required). This national trend in diminishing numbers of PTxs is disturbing and related to a number of factors including lack of a primary referral source and acceptance by the diabetes care community, changing donor and recipient demographics, and increasing risk aversion because of regulatory scrutiny. Conclusions: Given that the incidence of end stage renal disease secondary to diabetes remains static, a national initiative is needed to “re-invigorate” SPK and PAK transplants as preferred options for appropriately selected uremic patients taking insulin irrespective of C-peptide levels or “type” of diabetes. Moreover, many patients may benefit from PTA because all categories of PTx are not only life-enhancing but life-extending procedures.

CITATION INFORMATION: Stratta R, Gruessner A, Odorico J, Fridell J, Rogers J, Farney A, Orlando G, Gruessner R. Why Are Pancreas Transplants Declining in the United States in the Past Decade? Am J Transplant. 2016;16 (suppl 3).

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