Published online Jun 18, 2023. doi: 10.5500/wjt.v13.i4.147
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
Pancreas transplant is the only treatment that establishes normal glucose levels for patients diagnosed with diabetes. A significant advancement in management of diabetes associated with significant improvement in diabetic patients outcome has been achieved within the last decade. During the same period of time, there has been a noticeable decline in pancreas transplant procedures in the United States. In order to outline the importance of pancreas transplant as the only incurable treatment available for diabetes that could lead to normal glycemic status of these patients, we analyzed the outcome of pancreas transplant vs diabetic standard of care in the United States from 2008 to 2018.
A noticeable and significant decline of pancreas transplantation in the United States since 2004 has led to a decrease in the number of transplant centers that perform such procedure. This decline has led to a significant limitation among transplant surgeons and transplant physicians that are caring for patients receiving pancreas transplant. This study was to highlight the benefit of pancreas transplant in curing diabetes and to emphasize the potential benefit of pancreas transplantation in order to increase the number of diabetic patients that could receive this curative therapy.
The objective of this study was to bring pancreas transplant as a curative treatment, that could achieve glycemic control among diabetic patients, to the attention of transplant and endocrinology stakeholders. With the current technological advancement in treatment of diabetes, still a significant number of patients suffer from acute hyper and hypoglycemic events in addition to the chronic complications of diabetes. We hope that our research will at the current body of knowledge that supports pancreas transplant as a definitive treatment for diabetes and will encourage more clinical trials to compare standard of care for diabetes vs organ transplantation.
Our study utilized the United Network for Organ Sharing Standard Transplant Analysis and Research file. This database contains clinical and follow-up data for all transplants in the United States since 1988. We included all patients with type I diabetes listed for pancreas or kidney-pancreas transplant between May 31, 2008 and May 31, 2018 and compared their outcome with the patients that had type 1 diabetes and were being listed and waiting for an organ transplant.
The adjusted Cox proportional hazards models comparing survival between transplanted and non-transplanted patients in each transplant type group showed simultaneous pancreas and kidney transplant patients to exhibit a significantly reduced hazard of mortality [hazard ratio (HR) = 0.21, 95% confidence interval (CI): 0.19-0.25] compared to those not transplanted. Neither transplanted patients (HR = 8, 95%CI: 0.99-2.87) nor pancreas transplant alone 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.
Our study showed the survival advantage of simultaneous kidney and pancreas transplants compared to patients on the waiting list over the last decade. Patients who underwent pancreas transplant alone demonstrated no significant differences compared to patients who did not receive a transplant, which could highlight the importance of pancreas transplant alone despite the advancement in the technology of insulin delivery and diabetic management over the last decade.
We hope that our study will encourage future clinical trials to randomize patients between diabetic standard of care vs transplantation. Meanwhile, we are conducting further studies to address disparities among patients who are receiving pancreas transplant vs remaining on the waiting list. We are aiming to identify any barriers among minorities that could prevent their access to transplant evaluation and to receive an organ transplantation.