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Immunology and Transplantation
Outcomes of pancreas transplantation in older diabetic patients
  1. Enrique Montagud-Marrahi1,
  2. Alicia Molina-Andújar1,
  3. Adriana Pané2,
  4. Maria José Ramírez-Bajo3,
  5. Antonio Amor2,
  6. Enric Esmatjes2,
  7. Joana Ferrer4,
  8. Mireia Musquera5,
  9. Fritz Diekmann1,3,
  10. Pedro Ventura-Aguiar1,3
  1. 1Nephrology and Kidney Transplantation Department, Hospital Clinic de Barcelona, Barcelona, Spain
  2. 2Endocrinology Department, Hospital Clinic de Barcelona, Barcelona, Spain
  3. 3Laboratori Experimental de Nefrologia I Trasplantament (LENIT), CRB CELLEX, Fundació Clínic, IDIBAPS, Barcelona, Spain
  4. 4Hepatobiliopancreatic and Liver Transplant Department, Hospital Clinic de Barcelona, Barcelona, Spain
  5. 5Urology Department, Hospital Clinic de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Pedro Ventura-Aguiar; pventura{at}clinic.cat; Dr Fritz Diekmann; fdiekman{at}clinic.cat

Abstract

Objective Improvement in insulin alternatives is leading to a delayed presentation of microvascular and macrovascular complications of diabetes. The objective of this study was to evaluate the long-term outcomes of older (≥50 years) diabetic patients who receive a pancreas transplantation (PT).

Research design and methods We retrospectively evaluated all 338 PTs performed at our center between 2000 and 2016 (mean follow-up 9.4±4.9 years). Recipient and graft survivals were estimated for up to 10 years after PT. Major adverse cardiovascular events (MACEs) before and after PT were included in the analysis.

Results Thirty-nine patients (12%) were ≥50 years old (52.7±2.3 years) at the day of PT, of which 29 received a simultaneous pancreas–kidney transplantation (SPK) and 10 a pancreas after kidney transplantation (PAK). SPK recipients were first transplants, whereas in the PAK up to 50% were pancreas re-transplantations. Recipient and pancreas graft survivals at 10 years were similar between the group <50 years old and the older group for both SPK and PAK (log-rank p>0.05). The prevalence of MACE prior to PT was similar between both groups (31% vs 29%). Following PT, older recipients presented inferior post-transplant MACE-free survival. In a multivariate regression model, diabetes vintage (HR 1.054, p=0.03) and pre-transplantation MACE (HR 1.98, p=0.011), but not recipient age (HR 1.45, p=0.339), were associated with post-transplant MACE.

Conclusions Long-term survival of older pancreas transplant recipients are similar to younger counterparts. Diabetes vintage, but not age, increased the risk of post-transplantation MACE. These results suggest pancreas transplantation is a valuable treatment alternative to older diabetic patients.

  • pancreas transplantation
  • kidney transplantation
  • cardiovascular mortality
  • elderly
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000916

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    Footnotes

    • Twitter @QuimonMar

    • Contributors EM-M collected, analyzed, and interpreted the data and prepared the manuscript. AM-A collected the data. AP collected the data. MJR-B analyzed and interpreted the data. EE analyzed and interpreted the data. JF analyzed and interpreted the data. FD analyzed and interpreted the data. PV-A, collected, analyzed, and interpreted the data and prepared the manuscript. Statistical analysis was performed by PV-A with EM-M. There were no other contributions for this work but the authors’.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All relevant data for the study have been included in the main manuscript and/or in the online supplementary material. These data are not, in any case, linked to the patients they come from and are anonymized so that it is not possible to know which patients they come from.