Mortality assessment for pancreas transplants in the United States over the decade 2008-2018

Table 1 Demographic and clinical characteristics of patients listed for a pancreas transplant by transplant status and transplant type (May 31, 2008–May 31, 2018)

	SPK			PAK			PTA
	Transplant (n = 5834)	Waitlist (n = 3664)	P value	Transplant (n = 430)	Waitlist (n = 681)	P value	Transplant (n = 619)	Waitlist (n = 320)	P value
Age at registration (yr)			< 0.001			0.04			0.68
mean (SD)	40.1 (8.7)	41.0 (9.3)		40.6 (8.9)	41.8 (9.5)		41.7 (10.6)	41.4 (10.8)
Range	18.0 - 69.0	18.0 - 73.0		22.0 - 67.0	18.0 - 66.0		18.0 - 68.0	20.0 - 70.0
Gender			< 0.001			0.026			0.49
Female	2284 (39.1%)	1663 (45.4%)		174 (40.5%)	322 (47.3%)		378 (61.1%)	188 (58.8%)
Male	3550 (60.9%)	2001 (54.6%)		256 (59.5%)	359 (52.7%)		241 (38.9%)	132 (41.2%)
Race			0.3			0.08			< 0.001
White	3732 (64.0%)	2295 (62.6%)		336 (78.1%)	502 (73.7%)		567 (91.6%)	263 (82.2%)
Black	1229 (21.1%)	781 (21.3%)		37 (8.6%)	88 (12.9%)		25 (4.0%)	27 (8.4%)
Other	873 (15.0%)	588 (16.0%)		57 (13.3%)	91 (13.4%)		27 (4.4%)	30 (9.4%)
Ethnicity			0.22			0.7			0.012
Hispanic/Latino	714 (12.2%)	480 (13.1%)		46 (10.7%)	78 (11.5%)		23 (3.7%)	24 (7.5%)
Non-Hispanic/Non-Latino	5120 (87.8%)	3184 (86.9%)		384 (89.3%)	603 (88.5%)		596 (96.3%)	296 (92.5%)
Karnofsky score at registration			0.34			0.46			0.013
High	3441 (60.7%)	2151 (61.9%)		291 (70.3%)	427 (66.6%)		392 (64.9%)	229 (74.1%)
Middle	2108 (37.2%)	1259 (36.3%)		114 (27.5%)	199 (31.0%)		195 (32.3%)	76 (24.6%)
Low	121 (2.1%)	63 (1.8%)		9 (2.2%)	15 (2.3%)		17 (2.8%)	4 (1.3%)
BMI at registration			< 0.001			0.038			0.82
Normal	2847 (49.1%)	1640 (45.2%)		200 (46.9%)	287 (42.5%)		240 (40.1%)	133 (41.8%)
Underweight	95 (1.6%)	60 (1.7%)		5 (1.2%)	8 (1.2%)		11 (1.8%)	4 (1.3%)
Overweight	2180 (37.6%)	1311 (36.2%)		172 (40.4%)	259 (38.4%)		231 (38.6%)	116 (36.5%)
Obese	674 (11.6%)	615 (17.0%)		49 (11.5%)	121 (17.9%)		117 (19.5%)	65 (20.4%)
Duration of diabetes (yr)			0.064			0.052			0.28
mean (SD)	26.3 (9.0)	26.6 (9.2)		26.9 (8.6)	28.0 (9.5)		26.6 (11.4)	25.8 (11.7)
Range	0.0 - 59.0	0.0 - 60.0		3.0 - 49.0	2.0 - 55.0		0.0 - 58.0	1.0 - 57.0
Peripheral vascular disease at registration			< 0.001			0.96			0.78
No	5253 (91.5%)	3136 (87.4%)		384 (91.0%)	613 (91.1%)		545 (89.1%)	286 (89.7%)
Yes	488 (8.5%)	453 (12.6%)		38 (9.0%)	60 (8.9%)		67 (10.9%)	33 (10.3%)
Time on waitlist (yr)			< 0.001			< 0.001			< 0.001
mean (SD)	0.9 (1.0)	1.8 (1.7)		1.2 (1.1)	2.5 (2.0)		0.6 (0.8)	1.9 (1.9)
Range	0.0 - 7.4	0.0 - 10.3		0.0 - 5.9	0.0 - 9.9		0.0 - 6.7	0.0 - 10.0
Follow-up time after transplant (yr)
mean (SD)	3.7 (2.5)	NA		3.4 (2.6)	NA		3.3 (2.5)	NA
Range	0.0 - 10.1	NA		0.0 - 9.1	NA		0.0 - 9.1	NA

Continuous variables are presented as the mean and standard deviation (SD), and categorical variables are presented as frequency and percentage. SPK: Simultaneous pancreas-kidney; PAK: Pancreas after kidney; PTA: Pancreas transplant alone; NA: Not available.

Table 2 Adjusted Cox proportional hazards models comparing transplanted to non-transplanted patients within each transplant group

	SPK		PAK		PTA
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Transplanted (No)	Reference	Reference	Reference	Reference	Reference	Reference
Transplanted (Yes)	0.21 (0.19, 0.25)	< 0.001	1.68 (0.99, 2.87)	0.06	1.01 (0.53, 1.95)	0.97
Age at registration	1.01 (1.00, 1.02)	0.04	1.03 (1.00, 1.06)	0.02	1.03 (1.00, 1.06)	0.03
Gender (F)	Reference	Reference	Reference	Reference	Reference	Reference
Gender (M)	0.97 (0.86, 1.08)	0.55	0.55 (0.35, 0.88)	0.01	1.46 (0.90, 2.37)	0.13
Race (White)	Reference	Reference	Reference	Reference	Reference	Reference
Race (Black)	1.05 (0.91, 1.22)	0.47	1.82 (0.89, 3.71)	0.1	0.34 (0.05, 2.54)	0.29
Race (Other)	0.74 (0.62, 0.89)	0.001	0.77 (0.34, 1.74)	0.53	1.27 (0.45, 3.61)	0.66
BMI (Normal)	Reference	Reference	Reference	Reference	Reference	Reference
BMI (Obese)	0.76 (0.63, 0.90)	0	0.46 (0.21, 1.04)	0.06	0.80 (0.39, 1.65)	0.54
BMI (Overweight)	0.87 (0.77, 0.99)	0.03	0.66 (0.40, 1.10)	0.11	0.85 (0.50, 1.46)	0.57
BMI (Underweight)	1.16 (0.77, 1.75)	0.48	3.15 (0.90, 10.96)	0.07	1.76 (0.41, 7.64)	0.45
Duration of diabetes (yr)	1.00 (0.99, 1.01)	0.96	0.99 (0.96, 1.02)	0.62	0.98 (0.96, 1.01)	0.21
Karnofsky score (High)	Reference	Reference	Reference	Reference	Reference	Reference
Karnofsky score (Low)	0.98 (0.60, 1.60)	0.94	2.77 (0.96, 7.95)	0.06	3.07 (0.39, 24.14)	0.29
Karnofsky score (Middle)	1.42 (1.26, 1.60)	< 0.001	0.89 (0.52, 1.52)	0.66	2.22 (1.35, 3.64)	0
Peripheral vascular disease (No)	Reference	Reference	Reference	Reference	Reference	Reference
Peripheral vascular disease (Yes)	1.40 (1.19, 1.66)	< 0.001	0.98 (0.44, 2.16)	0.95	0.99 (0.47, 2.12)	0.99

SPK: Simultaneous pancreas-kidney; PAK: Pancreas after kidney; HR: Hazard ratios; CI: Confidence intervals; PTA: Pancreas transplant alone. Hazard ratios and 95% confidence intervals result from multivariate Cox proportional hazards models using transplant as a time-dependent covariate.

Table 3 Cox proportional hazards models comparing survival after transplant between transplant types

	Overall		Up to 90 d post-transplant		91-365 d post-transplant		Greater than 1 yr post-transplant
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
Transplant type (SPK)	Reference	Reference	Reference	Reference	Reference	Reference	Reference	Reference
Transplant type (PAK)	1.46 (1.07, 2.01)	0.02	0.25 (0.06, 1.03)	0.06	1.89 (0.89, 4.02)	0.1	1.59 (1.11, 2.30)	0.01
Transplant type (PTA)	1.22 (0.91, 1.65)	0.19	0.21 (0.05, 0.88)	0.03	1.31 (0.64, 2.68)	0.46	1.36 (0.96, 1.92)	0.08

SPK: Simultaneous pancreas-kidney; PAK: Pancreas after kidney; PTA: Pancreas transplant alone; CI: Confidence intervals; HR: Hazard ratios. Hazard ratios and 95% confidence intervals result from multivariate Cox proportional hazards models predicting survival after transplant among only transplanted patients and excluding time on the waiting list.