Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Jun 18, 2023; 13(4): 147-156
Published online Jun 18, 2023. doi: 10.5500/wjt.v13.i4.147
Mortality assessment for pancreas transplants in the United States over the decade 2008-2018
Tambi Jarmi, Emily Brennan, Jacob Clendenon, Aaron C Spaulding
Tambi Jarmi, Jacob Clendenon, Department of Transplant, Mayo Clinic Florida, Jacksonville, FL 32224, United States
Emily Brennan, Aaron C Spaulding, Health Science Research, Mayo Clinic Florida, Jacksonville, FL 32224, United States
Author contributions: Jarmi T and Spaulding A designed the study and wrote the paper; Clendenon J wrote the paper; Brennan ER and Spaulding A collected and analyzed the data and wrote the paper.
Institutional review board statement: This study was reviewed and approved by Mayo Clinic institutional review board (IRB application number 20-004621).
Informed consent statement: Informed consent from the patients was not required.
Conflict-of-interest statement: Sample wording: The authors of this study have nothing to disclose. All authors are employed by Mayo Clinic.
Data sharing statement: Statistical code and dataset are available from the corresponding author at jarmi.tambi@mayo.edu.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tambi Jarmi, MD, Chairman, Department of Transplant, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, United States. jarmi.tambi@mayo.edu
Received: January 4, 2023
Peer-review started: January 4, 2023
First decision: January 12, 2023
Revised: February 1, 2023
Accepted: April 20, 2023
Article in press: April 20, 2023
Published online: June 18, 2023
Abstract
BACKGROUND

Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes. However, since 2005, no comprehensive analysis has compared survival outcomes of: (1) Simultaneous pancreas-kidney (SPK) transplant; (2) Pancreas after kidney (PAK) transplant; and (3) Pancreas transplant alone (PTA) to waitlist survival.

AIM

To explore the outcomes of pancreas transplants in the United States during the decade 2008-2018.

METHODS

Our study utilized the United Network for Organ Sharing Standard Transplant Analysis and Research file. Pre- and post-transplant recipient and waitlist characteristics and the most recent recipient transplant and mortality status were used. We included all patients with type I diabetes listed for pancreas or kidney-pancreas transplant between May 31, 2008 and May 31, 2018. Patients were grouped into one of three transplant types: SPK, PAK, or PTA.

RESULTS

The adjusted Cox proportional hazards models comparing survival between transplanted and non-transplanted patients in each transplant type group showed that patients who underwent an SPK transplant exhibited a significantly reduced hazard of mortality [hazard ratio (HR) = 0.21, 95% confidence intervals (CI): 0.19-0.25] compared to those not transplanted. Neither PAK transplanted patients (HR = 1.68, 95%CI: 0.99-2.87) nor PTA patients (HR = 1.01, 95%CI: 0.53-1.95) experienced significantly different hazards of mortality compared to patients who did not receive a transplant.

CONCLUSION

When assessing each of the three transplant types, only SPK transplant offered a survival advantage compared to patients on the waiting list. PKA and PTA transplanted patients demonstrated no significant differences compared to patients who did not receive a transplant.

Keywords: Pancreas transplant, Simultaneous pancreas-kidney transplant, Pancreas after kidney transplant, Survival, Diabetes mellitus, Insulin

Core Tip: The total number of pancreas transplants has been in the decline in United States since 2003/2004. This study aimed to show acceptable survival outcome for diabetic patients receiving pancreas transplant as a cure therapeutic approach.