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Solitary pancreas transplantation: a review of the UK experience over a period of 10 yr
Author(s) -
Vrakas Georgios,
Arantes Rubens Macedo,
Gerlach Undine,
Reddy Srikanth,
Friend Peter,
Vaidya Anil
Publication year - 2015
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.12650
Subject(s) - medicine , immunosuppression , hazard ratio , univariate analysis , transplantation , multivariate analysis , body mass index , organ donation , pancreas transplantation , surgery , urology , kidney transplantation , confidence interval
Background The aim of this study was to see whether lessons could be learned from the prospectively maintained nationwide database on solitary pancreas transplantation ( SPT x) performed in the UK . Methods Two hundred and forty‐five SPT x were utilized from the 2004–2013 period (113 pancreas transplant alone and 132 pancreas after kidney). The statistical analysis included donor, recipient, transplant variables, and the effect of a rejection episode on graft survival. Results Cold ischemia time ( CIT ), CIT > 12 h, donor body mass index ( BMI ) > 30, and non‐lymphocyte‐depleting induction immunosuppression achieved p‐value <0.05 in the unadjusted univariate hazard model analysis. In a multivariate analysis, variables that persisted in demonstrating increased independent risk included CIT > 12 h (hazard ratio [ HR ] 1.94, p = 0.035) and the use of non‐depleting induction immunosuppression ( HR 1.95, p = 0.002). Factors such as bladder‐drained grafts and donor variables including age, BMI , and donation after cardiac death ( DCD ) vs. donation after brain‐stem death did not attain significance. Rejection reduces the overall graft survival by approximately 1000 d (1841 ± 114 d vs. 915 ± 119 d, p = 0.001). Conclusions Cold ischemia time <12 h and the use of depleting antibodies as induction immunosuppression have a positive effect on pancreas allograft survival. Other factors such as bladder‐drained grafts and donor variables such as age, BMI , and DCD status did not attain significance in a multivariate analysis.