AN UPDATE ON CARDIAC TRANSPLANTATION IN THE UNITED STATES BASED ON AN ANALYSIS OF THE UNOS REGISTRY
CH 4 : Kayo Waki, Aki Hayashi, Satoko Yamaguchi, Masaomi Nangaku, Kazuhiko Ohe, Takashi Kadowaki, and Norihiro Kokudo
Data collected by the United Network for Organ Sharing from all approved United States transplant programs were analyzed; the data included 20,290 adult diabetic patients who received primary pancreas transplants between October 1987 and December 2014. Simultaneous pancreas-kidney (SPK) transplantation has become the major therapeutic option for diabetes patients. The number of SPKs per year has not increased since 1999; it leveled off or decreased slightly each year. Recipients in the most recent period, 2010-2014, were more likely than recipients in any of the other periods to be non-white, older, male, to have had diabetes longer, to have higher body mass indices; and in this group there were more donor-recipient human leukocyte antigen mismatches. Donors in the 2010-2014 period were more likely to be younger and male and less likely to be white. Pancreas graft survival rates were highest in the 2010-2014 period (one-year graft survival 89.7%) vs. those for 1987-1989 (74.6%), 1990-1994 (77.5%), 1995-1999 (82.9%), 2000-2004 (84.4%), and 2005-2009 (85.5%); the five-year rates were 72.7% for 2010-14 vs. 60.0%, 64.3%, 69.0%, 70.9%, and 73.9% for the other periods, respectively. There was no decreased risk of graft failure for recent-era transplants compared with those of 1987–1989, except for those in 2005-2009. By year of transplant, the adjusted hazard ratios [with 95% confidence intervals (CI)] for overall loss of grafts surviving over one year in eras 1990–1994, 1995–1999, 2000–2004, 2005–2009, and 2010-2014 were, respectively, 0.85 (CI 0.66-1.09), 0.85 (CI 0.66-1.09), 0.87 (CI 0.67-1.13), 0.71 (CI 0.54-0.93), and 0.86 (CI 0.64–1.15). Chronic rejection caused 44.9% of graft losses between one and five years and 51.5% after five years. There is a need for a means to identify early markers of chronic rejection—and to control it—to improve long-term survival.
Long-Term Pancreas Allograft Survival in Simultaneous Pancreas-Kidney Transplantation by Era
- Product Code: CT15_Ch4
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