Improved Solitary Pancreas Transplant Graft Survival in the Modern Immunosuppressive Era
The results of solitary pancreas (SP) transplantation have traditionally lagged behind those of simultaneous pancreas–kidney (SPK) transplantation. This is one of the chief factors that has limited the wide-scale application of SP transplantation in nonuremic type I diabetic patients. The purpose of...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2000-11-01
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| Series: | Cell Transplantation |
| Online Access: | https://doi.org/10.1177/096368970000900620 |
| _version_ | 1828262389316845568 |
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| author | Jon S. Odorico Ph.D. Yolanda T. Becker Marilyn Groshek Cathy Werwinski Bryan N. Becker John D. Pirsch Hans W. Sollinger |
| author_facet | Jon S. Odorico Ph.D. Yolanda T. Becker Marilyn Groshek Cathy Werwinski Bryan N. Becker John D. Pirsch Hans W. Sollinger |
| author_sort | Jon S. Odorico Ph.D. |
| collection | DOAJ |
| description | The results of solitary pancreas (SP) transplantation have traditionally lagged behind those of simultaneous pancreas–kidney (SPK) transplantation. This is one of the chief factors that has limited the wide-scale application of SP transplantation in nonuremic type I diabetic patients. The purpose of this study is to report our present experience with SP transplantation and compare it to a prior experience. Twenty-three SP transplants (14 PAK, 4 PTA, and 5 PASPK) performed since January 1997 were compared to 56 SP transplants (53 PAK, 1 PTA, and 2 PASPK) performed before 1994. Between 1993 and 1997, SP transplants were not performed because of high morbidity in the early experience. Early SP transplants were performed using bladder drainage of exocrine secretions, and enteric drainage without a Roux-en-Y was used in the recent series. In the early era, immunosuppressive therapy included cyclosporine (CsA), azathioprine (AZA), corticosteroids, and in half of the patients, ALG or OKT3. Recent SP transplants received tacrolimus (TAC), mycophenolate mofetil (MMF), corticosteroids, and induction with either anti-thymocyte globulin (n = 9), OKT3 (n = 1), daclizumab (n = 5), or basiliximab (n = 8). The 1-year Kaplan-Meier patient survival was 85% in the early era and 100% in the recent group of patients (p = 0.08). In the previous era, four patients suffered significant decrement in renal function, necessitating dialysis or kidney transplantation following pancreas transplantation. All patients transplanted since 1997 maintain near prepancreas transplant levels of renal function [mean pretransplant serum creatinine (Cr) 1.3 ± 0.3 mg/dl vs. mean current Cr 1.4 ± 0.4 mg/dl, p = NS]. The 1-year Kaplan-Meier graft survival (insulin independence) of recent SP transplants was 87%, whereas for prior SP transplants it was 19% (p = 0.0001). The rate of acute pancreas rejection was significantly different between the two groups. Of early SP transplants, 76% experienced at least one rejection episode within the first year. In contrast, 35% of recent SP transplants suffered acute rejection during the same time period (p = 0.04). Current experience with SP transplantation demonstrates improved graft survival and reduced rejection rates with the use of newer immunosuppressive agents. |
| first_indexed | 2024-04-13T03:53:27Z |
| format | Article |
| id | doaj.art-a751556a79da4845b59f4255c557330a |
| institution | Directory Open Access Journal |
| issn | 0963-6897 1555-3892 |
| language | English |
| last_indexed | 2024-04-13T03:53:27Z |
| publishDate | 2000-11-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Cell Transplantation |
| spelling | doaj.art-a751556a79da4845b59f4255c557330a2022-12-22T03:03:42ZengSAGE PublishingCell Transplantation0963-68971555-38922000-11-01910.1177/096368970000900620Improved Solitary Pancreas Transplant Graft Survival in the Modern Immunosuppressive EraJon S. Odorico Ph.D.0Yolanda T. Becker1Marilyn Groshek2Cathy Werwinski3Bryan N. Becker4John D. Pirsch5Hans W. Sollinger6Division of Organ Transplantation, Department of Surgery, University of Wisconsin Medical School, Madison, WI 53792Division of Organ Transplantation, Department of Surgery, University of Wisconsin Medical School, Madison, WI 53792Division of Organ Transplantation, Department of Surgery, University of Wisconsin Medical School, Madison, WI 53792Division of Organ Transplantation, Department of Surgery, University of Wisconsin Medical School, Madison, WI 53792Division of Organ Transplantation, Department of Surgery, University of Wisconsin Medical School, Madison, WI 53792Division of Organ Transplantation, Department of Surgery, University of Wisconsin Medical School, Madison, WI 53792Division of Organ Transplantation, Department of Surgery, University of Wisconsin Medical School, Madison, WI 53792The results of solitary pancreas (SP) transplantation have traditionally lagged behind those of simultaneous pancreas–kidney (SPK) transplantation. This is one of the chief factors that has limited the wide-scale application of SP transplantation in nonuremic type I diabetic patients. The purpose of this study is to report our present experience with SP transplantation and compare it to a prior experience. Twenty-three SP transplants (14 PAK, 4 PTA, and 5 PASPK) performed since January 1997 were compared to 56 SP transplants (53 PAK, 1 PTA, and 2 PASPK) performed before 1994. Between 1993 and 1997, SP transplants were not performed because of high morbidity in the early experience. Early SP transplants were performed using bladder drainage of exocrine secretions, and enteric drainage without a Roux-en-Y was used in the recent series. In the early era, immunosuppressive therapy included cyclosporine (CsA), azathioprine (AZA), corticosteroids, and in half of the patients, ALG or OKT3. Recent SP transplants received tacrolimus (TAC), mycophenolate mofetil (MMF), corticosteroids, and induction with either anti-thymocyte globulin (n = 9), OKT3 (n = 1), daclizumab (n = 5), or basiliximab (n = 8). The 1-year Kaplan-Meier patient survival was 85% in the early era and 100% in the recent group of patients (p = 0.08). In the previous era, four patients suffered significant decrement in renal function, necessitating dialysis or kidney transplantation following pancreas transplantation. All patients transplanted since 1997 maintain near prepancreas transplant levels of renal function [mean pretransplant serum creatinine (Cr) 1.3 ± 0.3 mg/dl vs. mean current Cr 1.4 ± 0.4 mg/dl, p = NS]. The 1-year Kaplan-Meier graft survival (insulin independence) of recent SP transplants was 87%, whereas for prior SP transplants it was 19% (p = 0.0001). The rate of acute pancreas rejection was significantly different between the two groups. Of early SP transplants, 76% experienced at least one rejection episode within the first year. In contrast, 35% of recent SP transplants suffered acute rejection during the same time period (p = 0.04). Current experience with SP transplantation demonstrates improved graft survival and reduced rejection rates with the use of newer immunosuppressive agents.https://doi.org/10.1177/096368970000900620 |
| spellingShingle | Jon S. Odorico Ph.D. Yolanda T. Becker Marilyn Groshek Cathy Werwinski Bryan N. Becker John D. Pirsch Hans W. Sollinger Improved Solitary Pancreas Transplant Graft Survival in the Modern Immunosuppressive Era Cell Transplantation |
| title | Improved Solitary Pancreas Transplant Graft Survival in the Modern Immunosuppressive Era |
| title_full | Improved Solitary Pancreas Transplant Graft Survival in the Modern Immunosuppressive Era |
| title_fullStr | Improved Solitary Pancreas Transplant Graft Survival in the Modern Immunosuppressive Era |
| title_full_unstemmed | Improved Solitary Pancreas Transplant Graft Survival in the Modern Immunosuppressive Era |
| title_short | Improved Solitary Pancreas Transplant Graft Survival in the Modern Immunosuppressive Era |
| title_sort | improved solitary pancreas transplant graft survival in the modern immunosuppressive era |
| url | https://doi.org/10.1177/096368970000900620 |
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