Elsevier

Surgery

Volume 124, Issue 4, October 1998, Pages 823-830
Surgery

Original Articles from the Central Surgical Association
Mortality after vascularized pancreas transplantation

Presented at the Fifty-fifth Annual Meeting of the Central Surgical Association, Ann Arbor, Mich, March 5-7, 1998.
https://doi.org/10.1067/msy.1998.91366Get rights and content

Abstract

Background: Previous studies have questioned the safety of vascularized pancreas transplantation (PTX), particularly because diabetes is an independent risk factor for coronary artery disease and cardiac death. Methods: A retrospective analysis of the timing and causes of death after PTX was performed. From April 1989 through December 1995, 196 PTXs were performed in 186 diabetic patients including 134 simultaneous kidney-PTXs, 59 solitary PTXs, and 3 combined liver-PTXs. All patients underwent whole organ PTX with bladder drainage, received triple or quadruple immunosuppression, and had a minimum follow-up of 1 year (mean 3.8 years). Results: A total of 22 patients (12%) died at a mean of 19 months after PTX. Infection was the most common cause of early death, whereas the majority of late deaths were due to cardiac causes. In the 8 deaths caused by infection, 6 were associated with operative complications, but only 2 received excessive immunosuppression for rejection. In the 10 cardiac deaths, 6 patients were older than 40 years at the time of PTX and 4 had experienced pancreas graft loss before death. Four-year actuarial patient survival was 92% after simultaneous kidney-PTX and 87% after solitary PTX. Conclusions: In this series, the mortality rate after PTX was 12%, with infection, myocardial infarction, and sudden death accounting for over 80% of deaths. Deaths from infection most commonly occurred early and were associated with operative complications, whereas cardiac deaths usually were late and related to recipient age or preceded by pancreas graft loss. Future strategies aimed at reducing mortality after PTX should emphasize appropriate recipient selection and target prevention of operative complications. (Surgery 1998;124:823-30.)

Section snippets

Material and methods

From April 1989 through December 1995, 196 PTXs were performed in 186 diabetic patients at our center including 134 SKPTs, 59 solitary PTXs (42 PTA, 17 PAKT), and 3 combined liver-PTX (LP). All patients underwent a comprehensive pretransplantation evaluation as outlined previously.13 The medical evaluation was tailored to the individual based on specific signs or symptoms. The work-up was used to confirm the diagnosis of IDDM, determine the patient's operative risks, establish the absence of

Results

During a 7-year period, 196 PTXs were performed in 186 IDDM patients. Demographic and clinical characteristics of the study groups according to type of PTX are summarized in Table I. The mean age of the recipient group was 37 years with a mean duration of diabetes of 25 years at the time of PTX. A total of 58 patients (31%) had evidence of cardiac disease before transplantation. In the 134 patients undergoing SKPT, 73 (55%) received pretransplantation dialysis.

Results are depicted in Table II.

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Discussion

With improvements in organ retrieval technology, surgical techniques, clinical immunosuppression, antimicrobial prophylaxis, and diagnostic methodology, success rates for vascularized PTX have steadily improved.11, 14 As a result, PTX has assumed an increasingly important role in the treatment of IDDM. In spite of increased morbidity, the addition of a pancreas transplantation to a kidney transplantation in an appropriately selected IDDM patient does not appear to jeopardize either the patient

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