PMID- 23095622
OWN - NLM
STAT- MEDLINE
DCOM- 20130104
LR  - 20130319
IS  - 1528-1140 (Electronic)
IS  - 0003-4932 (Linking)
VI  - 256
IP  - 5
DP  - 2012 Nov
TI  - Evolution of pancreas transplantation: long-term results and perspectives from a 
      high-volume center.
PG  - 780-6; discussion 786-7
LID - 10.1097/SLA.0b013e31827381a8 [doi]
AB  - OBJECTIVE: To describe the evolution of pancreas transplantation from 1979 to 
      2011. The aim was to examine factors influencing long-term patient and graft 
      survival, surgical methods, and risk factors influencing organ performance after 
      transplantation. BACKGROUND: Pancreas transplantation has become the therapy of 
      choice for patients suffering insulin-dependent diabetes and end stage renal 
      failure. METHODS: Retrospective analysis of 509 consecutive pancreas transplants 
      (442 simultaneous pancreas and kidney [SPK], 20 pancreas transplanted alone 
      [PTA], and 47 pancreas transplanted after kidney [PAK]), performed at the 
      University Hospital Innsbruck. The data were statistically analyzed using the 
      Kaplan-Meier method and log-rank test. RESULTS: After overcoming initial 
      immunological and technical problems between 1979 and 1988 (5-year pancreas graft 
      survival rate, 29.7%), pancreas transplantation evolved during the second decade 
      (1989-1996; 5-year pancreas graft survival rate, 42.2%). Technical changes, 
      optimized immunosuppression, careful pretransplant evaluation, and improved graft 
      monitoring have become standard in the last decade and result in excellent 5-year 
      patient (94.3%), kidney (89.4%), and pancreas (81.5%) graft survival. Five-year 
      graft survival was superior in SPK (68.8%) compared with PAK (62.5%) and PTA 
      (16.4%). SPK retransplantation can be carried out safely with 5-year patient 
      (87.5%) and pancreas graft (75.0%) survival. Overall 5-year patient survival 
      after loss of the first pancreas graft is significantly better in patients who 
      underwent retransplantation (89.4% vs. 67.9%, P = 0.001). Long-term pancreas 
      graft survival is independent of donor body mass index, sex, and cause of death, 
      anastomosis time and the number of human leukocyte antigen (HLA) mismatches, 
      recipient age, body mass index, sex, current panel reactive antibodies, and 
      waiting time. Significant risk factors for reduced graft survival are cold 
      ischemia time and donor age. CONCLUSIONS: During the last 32 years, many problems 
      in pancreas transplantation have been overcome and it may currently represent the 
      therapeutic gold standard for some patients with diabetes and end stage renal 
      failure.
FAU - Ollinger, Robert
AU  - Ollinger R
AD  - Department of Visceral, Transplant and Thoracic Surgery, Medical University 
      Innsbruck, Anichstrasse 35, Innsbruck, Tyrol, Austria. 
      robert.oellinger@i-med.ac.at
FAU - Margreiter, Christian
AU  - Margreiter C
FAU - Bosmuller, Claudia
AU  - Bosmuller C
FAU - Weissenbacher, Annemarie
AU  - Weissenbacher A
FAU - Frank, Florian
AU  - Frank F
FAU - Schneeberger, Stefan
AU  - Schneeberger S
FAU - Mark, Walter
AU  - Mark W
FAU - Margreiter, Raimund
AU  - Margreiter R
FAU - Pratschke, Johann
AU  - Pratschke J
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Ann Surg
JT  - Annals of surgery
JID - 0372354
SB  - IM
EIN - Ann Surg. 2013 Mar;257(3):570
MH  - Adolescent
MH  - Adult
MH  - Analysis of Variance
MH  - Austria/epidemiology
MH  - Cause of Death
MH  - Child
MH  - Diabetes Mellitus, Type 1/*surgery
MH  - Female
MH  - Graft Survival
MH  - Humans
MH  - Kidney Failure, Chronic/*surgery
MH  - Kidney Transplantation
MH  - Male
MH  - Middle Aged
MH  - *Pancreas Transplantation/methods/mortality
MH  - Postoperative Complications/mortality
MH  - Proportional Hazards Models
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Rate
EDAT- 2012/10/26 06:00
MHDA- 2013/01/05 06:00
CRDT- 2012/10/26 06:00
PHST- 2012/10/26 06:00 [entrez]
PHST- 2012/10/26 06:00 [pubmed]
PHST- 2013/01/05 06:00 [medline]
AID - 00000658-201211000-00015 [pii]
AID - 10.1097/SLA.0b013e31827381a8 [doi]
PST - ppublish
SO  - Ann Surg. 2012 Nov;256(5):780-6; discussion 786-7. doi: 
      10.1097/SLA.0b013e31827381a8.