Introduction: In contrast to non-pancreatic transplantation, where nephrologists refer patients for kidney and hepatologists for liver transplantation, endocrinologists only rarely refer patients with brittle diabetes for solitary pancreas transplantation. While most pancreas transplants are performed in combination with a kidney graft, solitary pancreas transplants (PTA) without a previous kidney transplant accounted for only 6-7% of pancreas transplants per year although a PTA is the best treatment option to achieve long-term insulin-independence in patients with severe brittle diabetes.
Methods: The change in demographics and outcome of 1,636 primary PTAs were analyzed between 20 and 2020 in 5-year intervals. Graft survival was defined as complete insulin-independence. Multivariate analysis was performed to assess factors that impacted outcome and the potential need for a subsequent kidney transplant.
Results: Over time, recipient age increased, but donor age and preservation time decreased significantly. Most recipients received induction therapy and maintenance immunosuppression. These changes resulted in significant improvement in patient and pancreas graft survival. Three-year patient survival increased from 92% in 2001-to 96% in 2016-20. Three-year pancreas graft survival improved from 60% in 2001-to 77% in 2016-20 (p<0.0001) . The most influential factors for this decrease were older recipient age and better immunosuppression. The rate of a subsequent kidney transplant declined significantly. It was primarily contingent on native graft function at the time of transplant. If the GFR was as >70ml/min only 1% of patients required a kidney graft.
Conclusion: The results of PTA have significantly improved over the past 20 years. A PTA should be strongly considered in brittle diabetic patients before the development of advanced nephropathy.