Survival Advantages of Pancreas Transplantation

Abstract

The field of transplantation has provided tremendous progress to diabetic patients. One way to objectify this development is to determine the survival advantage of transplantation in the 4 diabetic recipient categories: simultaneous pancreas and kidney transplantation (SPK), pancreas after kidney transplantation (PAK), pancreas transplantation alone (PTA), and kidney transplantation alone (KTA). Over a 21-year time period, from January 1, 2000, to May 31, 2021, the IPTR/UNOS collected information about listing and transplant outcome of diabetic patients. A total of 212,049 patient records were reviewed: 89,579 recipients who underwent pancreas and/or kidney transplantation and 122,470 patients who were placed on the waiting list and are still waiting or were removed from the waitlist due to deteriorating health or death. To determine the survival advantage of pancreas transplantation, patient survival on the waiting list versus after transplantation was defined as the primary outcome. Over the 21-year time period, pancreas and/or kidney transplantation in all 4 diabetic recipient categories saved a total of 273,843 life-years. On average, 11.7 life-years per patient were saved in the SPK category, 6.4 life-years in the PTA category, 6.3 life-years in the PAK category, and 6.6 life-years in the KTA category. The survival advantage of pancreas and/or kidney transplant recipients was highly significant compared to diabetic patients still waiting for transplantation. The survival advantage was higher for patients with type 1 vs. type 2 diabetes mellitus. The significant survival advantage of PTA recipients versus patients on the waiting list justifies the argument for pre-emptive pancreas transplantation, i.e., before the development of end-stage renal disease. Given the survival advantage as evidenced in 273,843 life-years saved, pancreas transplantation should be more widely applied, and pancreas donation encouraged.