International Pancreas Transplant Registry Report – 1988

From December 1966 to December 31, 1988, 1830 pancreas transplants are known to have been performed. Of these, 1775 were reported to the International Pancreas Transplant Registry as of January 19, 1989, the date of this analysis. One‐year actuarial graft function (insulin‐independent) and recipient survival rates for all cases were 43% and 81%, respectively. In an analysis by era of 1966–77 (n = 64), 1978–83 (n = 336), 1984–85 (n = 387) and 1986–88 (n = 988) cases, 1‐yr graft function rates were 5%, 26%, 40% and 54% and recipient survival rates were 44%, 73%, 81% and 87%, respectively (p ≤ 0.01 all comparisons). In an analysis of 1984–1988 cases only (n = 1375), the overall 1‐yr graft function and patient survival rates were 50% and 85%, respectively. During this period, graft functional survival rates for the most common duct management methods were 54% for bladder drainage (n = 695), 50% for duct injection (n = 354), and 43% for intestinal drainage (n = 271) at 1 yr (p < 0.05 for bladder vs. intestinal drainage and duct injection). Graft function rates were similar for whole (n = 690) and segmental (n = 628) pancreas transplants (51% vs 48% at 1 yr). Functional survival rates according to duration of preservation for grafts stored <6 hours (n = 790), 6–12 h (n = 315), 12–24 h (n= 139) and 12–24 h (n = 19) were 50%, 45%. 49% and 69% at 1 yr, and none of these differences was significant. Graft functional survival rates for 1984–88 cases were significantly higher (p < 0.02) in recipients who received azathioprine (AZA) and cyclosporine (CSA) in combination (n = 1105) than in those who received CSA without azathioprine (n = 221) or AZA without cyclosporine, (n = 33), with 1 yr graft functional survival rates of 52%, 41% and 34%, respectively. For technically successful grafts, the functional survival rates were also significantly higher (p ≤ 0.05) in recipients treated with CSA + AZA (n = 871) than in those who received CSA without azathioprine (n = 160) or AZA without cyclosporine (n = 23), with 1 yr function rates of 66%, 56% and 49%, respectively. The combination of CSA and AZA did not have a detrimental effect on patient survival; for all cases, the 1‐yr survival rate for recipients treated with both CSA and AZA was 87%, versus 78% in those treated with CSA without azathioprine (p = 0.001) and 79% in those treated with AZA without cyclosporine (p ≤ 0.05). Graft survival rates were significantly higher (p < 0.01) in recipients treated (n = 613) than not treated (n = 746) with antilymphocyte globulin or OKT3, 53% and 48% at 1 yr. HLA matching or mismatching influenced graft survival rates only at the DR loci, with mismatches for 0 (n = 111), 1 (n = 497) and 2 (n = 423) DR antigens associated with 1‐yr graft survival rates of 61%, 47%, and 47% for all cases and 74% (n = 90). 63% (n = 371) and 61% (n = 336) for technically successful cases (p ≤ 0.03 for 0 versus 1 or 2 mismatches for all and for 0 vs 2 mismatches for TS cases). For 1984–88 cases, pancreas graft survival rates were significantly higher (p < 0.001) in recipients of simultaneous kidney transplants (n = 924) than in recipients of pancreas transplants after a kidney (n = 243) or recipients of pancreas transplants alone (n = 200), 56%, 42%. and 32% at 1 yr, respectively. Patient survival rates, however, were significantly higher (p < 0.01) in recipients of a pancreas transplant alone or pancreas after a kidney transplant (91% at 1 yr), than in recipients of a simultaneous pancreas and kidney transplant (82% at 1 yr). The renal graft functional survival rate for kidneys transplanted simultaneously with a pancreas was 73% at 1 yr. Analysis of the results according to combination of surgical technique and recipient category showed that 1 yr pancreas graft survival rates were highest in recipients of simultaneous kidney transplants in all duct management categories. Within the various recipient categories there were no significant differences in pancreas graft survival rate according to technique, except for uremic recipients of simultaneous kidney transplants where bladder drainage was associated with a significantly higher pancreas graft survival rate than either intestinal drainage or duct injection. Bladder drainage continues to be applied with increasing frequency, and the proportion of recipients in the simultaneous pancreas/kidney transplant category continues to be higher than in the other two categories.