Recipient risk factors have an impact on technical failure and patient and graft survival rates in bladder-drained pancreas transplants

Rainer W G Gruessner, David L. Dunn, Angelika C. Gruessner, Arthur J. Matas, John S. Najarian, David E R Sutherland

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Abstract

Recipient selection criteria for pancreas (Px) transplantation differ among centers, based on perceived recipient risk factors, and their validity has not been determined. At the University of Minnesota we have been very liberal in accepting patients for Tx, some of whom have risk factors cited as exclusion criteria by other centers, giving us the opportunity to determine, retrospectively, the impact of their presence on outcome. Between July 1986 and March 1993, we performed 319 bladder-drained cadaver Px Txs at the University of Minnesota, 166 simultaneous with a kidney (SPK), 68 after a kidney (PAK), and 85 alone (PTA). To determine which putative “risk factors” influence patient and graft survival, we used uni- and multivariate (Cox regression) analyses to assess the impact of recipient category, duration of diabetes, and age at onset and at Tx; presence of pre-Tx cardiac (CD) disease (myocardial infarction, bypass, angioplasty), peripheral vascular disease (PVD) (stroke, bypass, angioplasty, amputation); blindness, hypertension, and excess weight; and of Px re-Txs. The incidences of all risk factors except re-Tx were significantly higher in SPK than PTA recipients. Px re-Txs comprised 40% of PAK, 26% of PTA, and 10% of SPK cases (P<0.0001). Duration of diabetes correlated (P≤0.01) with all risk factors but one (hypertension). Recipient age correlated (P≤0.01) with CD, blindness, duration of diabetes, and age at onset of diabetes; CD risk factors correlated (P<0.015) with hypertension and PVD. Recipient age (≥ 45) influenced the technical failure rate only in SPK recipients, with a relative risk (RR) of 2.13 (P=0.08). Recipient age influenced Px graft and patient survival rates in both SPK and PAK recipients; for those ≥ 45, the RR of graft loss was 1.73 and 1.76, respectively CP≤0.25), and the RR for ultimately dying was 3.07 in PAK (P=0.02) and 5.86 in SPK (P=0.17) recipients. SPK recipients with CD factors were at higher risk to ultimately die (RR=3.78, P=0.009), independent of age. Px re-Txs were not at higher risk to fail in PTA, but were in PAK recipients (RR=1.86, P=0.09); the risk for technical failure was higher for re-Txs only in SPK recipients (RR=2.11, P=0.24). Blindness, hypertension, PVD, and duration of diabetes did not negatively influence patient and graft outcome in any recipient category. Px Txs can succeed in all groups, but age and CD are risk factors in SPK and PAK recipients. The best results are in young SPK recipients without CD risk factors. PTA recipients have a low rate of risk factors, but even when present, they do not affect patient or graft survival rates (overall 98% and 55%, respectively, at 1 year). PTA is used mainly to treat patients with extremely labile diabetes causing low quality of life; it is a very safe procedure that establishes long-term insulin independence in more than half of the recipients.

Original languageEnglish (US)
Pages (from-to)1598-1606
Number of pages9
JournalTransplantation
Volume57
Issue number11
DOIs
StatePublished - Jun 1994

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