Longterm survival and function of pancreas grafts are equivalent in pancreas-after-kidney and simultaneous pancreas/kidney transplant recipients

M.S. Cattral, F. Bazerbachi, I.D. McGilvray, A. Norgate, J Schiff, M Selzner
Toronto General Hospital, University of Toronto, Toronto, Canada

Introduction: Registry data showing that pancreas graft survival is inferior in PAK recipients than in SPK recipients continue to influence transplant decisions. In this single-institution study, we compared the results of all PAK (n=49) and SPK (n=123) transplants performed between 8/2002 and 1/2010. Methods: Systemic venous drainage and enteric drainage was used for all pancreas grafts. Most patients received thymoglobulin and were maintained on tacrolimus, mycophenolate mofetil and prednisone. Demographics, graft survival, complications, and mortality were analyzed by the Chi-square, Fisher’s exact, and log-rank tests.

Results: Donor and recipient demographics were similar in both groups. All patients were dialysis-dependent for 2.4 ± 1.8 yrs prior to their kidney transplant (KTx); the time interval between KTx and PAK was 6 ± 4 yrs. For PAK vs. SPK recipients, there was no difference in length of hospital stay (9.7 ± 3.6 d vs.14.3 ± 11.2 d) or incidence of infectious (31% vs. 35%) and non-infectious (8%vs. 22%) complications including graft thrombosis (2% vs. 3%). The 1-, 3-, and 5-yr patient survival rates for SPK patients were 100%, 96%, and 92% (f/u, 53 ± 25 mo), whereas all PAK patients were alive with functioning KTx at these time points (f/u, 46 ± 28 mo). The 1-, 3-, and 5-yr uncensored pancreas graft survival rates for PAK vs. SPK were 90% vs. 93%; 90% vs. 92%; and 87% vs. 83%, respectively (p=NS). The duration of dialysis and the time interval between KTx and PAK did not influence outcome. Glycemic control as determined by fasting blood glucose and HbA1c levels, and annual oral glucose tolerance testing was similar in both groups.

Conclusion: In the current era, pancreas graft outcomes in PAK and SPK recipients are similar. PAK should be the preferred option for patients who have access to a live-donor kidney graft.