NIV Congres

Introduction The past decades there has been a lot of development in the field of pancreas transplantation. Here we describe the experiences of our center over the past 28 years. OBJECTIVE Evaluation of all pancreas transplantations performed at our center.

Methods All pancreas transplantations performed at our center from 1984 till 2011 were analysed. Univariate and multivariate analysis were performed to identify significant donor, transplant and recipient risk factors. This cohort was divided into two groups, using the start of modern immunosuppressive therapy (induction therapy) in 1999 as dividing point.

Results A total of 322 pancreas transplants were performed, of which 304 primary pancreas transplants (298 SPK, 4 PAK and 2 PTA) and 18 re-transplants (3 SPK, 14 PAK and 1 PTA). Donor factors were: age 35 years (median), BMI 23 (median), CVA-related COD 56% and DCDD donors 1.6%. Transplant factors were: 65% regional allocation and 91% UW perfusion fluid. Recipient factors were: age 42 years (median) and 43% pre-emptive transplantation. In the more recent group recipients were significantly older (43 years vs. 39 years; p=0.026) and a higher rate of re-transplants was performed (7% vs. 3%; p=0.067). Median P-PASS was16 and PDRI was 1.24. Throughout the years there was a trend in increasing (median) PDRI ranging from 1.1 to 1.4 in more recent years (p=0.12). Overall (death-censored) pancreas graft survival was 77% at 5 years and 73% at 10 years follow-up. When analysing the two groups separately, group I had 70% at 5 years and 67% at 10 years, group II had 81% at 5 years and 75% at 10 years. Overall 5- and 10 year patient survival rates were 86% and 73%. For SPK transplants results were even better (group II 5- and 10-year graft survival 83% and 76%). Thrombosis rates were not significantly different: group I 11% and group II 8% (p=0.36). Results of the univariate and multivariate analysis for risk factors are currently processed.

Conclusion Over the past 28 years, pancreas transplantation has developed tremendously. Regardless of the more liberal acceptance concerning donor quality and recipient condition, results improved and are currently at a high level. Furthermore, despite improved outcome of the more recent pancreas transplant cohort, there is still 8% graft thrombosis, which remains a significant concern, as is also described in the literature (10-15%).