Author(s): Venstrom JM, McBride MA, Rother KI, Hirshberg B, Orchard TJ,
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Abstract CONTEXT: Solitary pancreas transplantation (ie, pancreas alone or pancreas-after-kidney) for diabetes mellitus remains controversial due to procedure-associated morbidity/mortality, toxicity of immunosuppression, expense, and unproven effects on the secondary complications of diabetes. Whether transplantation offers a survival advantage over conventional therapies for diabetes is unknown. OBJECTIVE: To determine the association between solitary pancreas transplantation and survival in patients with diabetes and preserved kidney function. DESIGN, SETTING, AND PATIENTS: Retrospective observational cohort study conducted at 124 transplant centers in the United States, in 11 572 patients with diabetes mellitus on the waiting list for pancreas transplantation (pancreas alone, pancreas-after-kidney, or simultaneous pancreas-kidney) at the United Network for Organ Sharing/Organ Procurement and Transplantation Network between January 1, 1995, and December 31, 2000. All patients receiving a multiorgan (other than simultaneous pancreas-kidney) transplant were excluded, as were those listed for solitary pancreas transplantation who had a serum creatinine level greater than 2 mg/dL (176.8 micromol/L) at time of listing, or who ultimately received a simultaneous pancreas-kidney transplant. MAIN OUTCOME MEASURE: All-cause mortality within 4 years following transplantation (or within a comparable time on the waiting list for the group not undergoing transplantation). RESULTS: Overall relative risk of all-cause mortality for transplant recipients (compared with patients awaiting the same procedure) over 4 years of follow-up was 1.57 (95\% confidence interval [CI], 0.98-2.53; P =.06) for pancreas transplant alone, 1.42 (95\% CI, 1.03-1.94; P =.03) for pancreas-after-kidney transplant, and 0.43 (95\% CI, 0.39-0.48) for simultaneous pancreas-kidney transplant. Transplant patient 1- and 4-year survival rates were 96.5\% and 85.2\% for pancreas transplant alone, respectively, and 95.3\% and 84.5\% for pancreas-after-kidney transplant, while 1- and 4-year survival rates for patients on the waiting list were 97.6\% and 92.1\% for pancreas transplant alone, respectively, and 97.1\% and 88.1\% for pancreas-after-kidney transplant. CONCLUSION: From 1995-2000, survival for those with diabetes and preserved kidney function and receiving a solitary pancreas transplant was significantly worse compared with the survival of waiting-list patients receiving conventional therapy.
This article was published in JAMA
and referenced in Journal of Bioengineering and Bioelectronics