Pancreas transplantation: The Wake Forest experience in the new millennium

Table 1 Donor and recipient characteristics in African-American vs non-African-American recipients

	AA	Non-AA	P value
	n = 39	n = 1631
Donor age (yr)	24.7 ± 10.2	25.2 ± 9.4	NS
Donor BMI (kg/m2)	23.6 ± 5.4	23.7 ± 2.8	NS
Cold ischemia time (h)	15.8 ± 4.6	16.3 ± 3.8	NS
5-6 HLA-mismatch	25 (64.1%)	68 (41.7%)	0.01
HLA-mismatch	4.8 ± 1.0	4.4 ± 1.2	NS
PRA > 10%	11 (28.2%)	17 (10.4%)	0.008
CMV Recipient negative	11 (28.2%)	78 (47.9%)	0.03
CMV D+/R-	7 (17.9%)	45 (27.6%)	NS
Retransplant	2 (5.1%)	14 (8.6%)	NS
Portal-enteric technique	30 (76.9%)	149 (91.4%)	0.02
SKPT	36 (92.3%)	126 (77.3%)
SPT	3 (7.7%)	37 (22.7%)	0.04
Recipient age	41.7 ± 9.8	43.0 ± 10.4	NS
Recipient gender: male	20 (51.3%)	94 (57.7%)	NS
Recipient weight ≥ 80 kg	20 (51.3%)	39 (23.9%)	0.001
Recipient weight	70.9 ± 11.9	71.2 ± 12.7	NS
Dialysis history: SKPT hemodialysis	29/36 (80.6%)	54/126 (42.9%)
Peritoneal dialysis	5/36 (13.9%)	37/126 (29.4%)
None (preemptive)	2/36 (5.5%)	35/126 (27.8%)	0.004
Duration of dialysis: SKPT (mo)	31.8 ± 15.1	15.6 ± 17.8	0.02
Duration of pretransplant diabetes ≤ 18 yr	15 (38.5%)	27 (16.6%)	0.004
Duration of diabetes (yr)	19.7 ± 8.4	26.9 ± 8.6	0.03
Age of onset of diabetes	20 ± 8	16 ± 6	NS
SKPT waiting time (mo)	11.5 ± 6.4	9.7 ± 7.2	NS
C-peptide positive	14 (35.9%)	16 (9.8%)	0.001

¹161 Caucasian, 1 Asian, 1 Hispanic ethnicity. AA: African-American; BMI: Body mass index; HLA: Human leukocyte antigen; CMV: Cytomegalovirus; PRA: Panel reactive antibody; SKPT: Simultaneous kidney-pancreas transplantation; SPT: Solitary pancreas transplantation; NS: Not significant.

Table 2 Outcomes in African-American vs non-African-American recipients

	AA	Non-AA	P value
	n = 39	n = 1631
Patient survival	35 (89.7%)	141 (86.5%)	NS
Death with functioning grafts	1 (2.6%)	14 (8.6%)	NS
Kidney graft survival	26 (66.7%)	123/159 (77.4%)	NS
Death-censored kidney graft survival	26/37 (70%)	123/143 (87%)	0.03
Pancreas graft survival	23 (59%)	108 (66.3%)	NS
Death-censored pancreas graft survival	23/37 (62%)	108/148 (73%)	NS
Death-censored dual graft loss	8/37 (21.6%)	9/142 (6.3%)	0.01
Follow-up (mo)	64.9 ± 38.2	69.8 ± 28.6	NS
Relaparotomy	18 (46.2%)	58 (35.6%)	NS
Early thrombosis	4 (10.3%)	12 (7.4%)	NS
Acute rejection	13 (33.3%)	44 (27.0%)	NS

¹161 Caucasian, 1 Asian, 1 Hispanic ethnicity. AA: African-American; NS: Not significant.

Table 3 Donor and recipient characteristics according to pancreas transplantation category

	SKPT	SPT	P value
	n = 162 in 161 patients1	n = 40 in 38 patients1
Donor age (yr)	27.3 ± 10.6	22 ± 7.6	0.004
Donor BMI (kg/m2)	23.9 ± 1.4	23.5 ± 6.8	NS
Donation after cardiac death donors	5 (3.1%)	0	NS
Cold ischemia time (h)	16.2 ± 7.4	14.8 ± 3.8	NS
HLA-mismatch	4.5 ± 1.2	2.7 ± 1.5	< 0.001
PRA > 10%	27 (16.7%)	8 (20%)	NS
CMV Donor+/Recipient-	45 (27.8%)	11 (27.5%)	NS
Retransplant	2 (1.2%)	14 (35%)	< 0.001
Portal-enteric technique	147 (90.7%)	32 (80%)	0.09
Recipient age (yr)	42.7 ± 11.3	42.2 ± 8.7	NS
Patients aged 50 or older	42 (26.1%)	8 (21.1%)	NS
Recipient gender: male	94 (58.0%)	19 (50%)	NS
Recipient: AA	36 (22.2%)	3 (7.9%)	0.03
Recipient weight (kg)	71.1 ± 13.5	70.7 ± 12.8	NS
Dialysis history: hemodialysis	82 (50.9%)	NA
Peritoneal dialysis	42 (26.1%)
None (preemptive)	37 (23.0%)
Duration of pretransplant diabetes (yr)	25.3 ± 9.8	26.7 ± 7.7	NS
Waiting time (mo)	10.1 ± 6.3	5.8 ± 7.2	0.002

¹One patient had 2 SKPTs, two had 2 SPTs, and seven had SKPT followed by SPT. AA: African-American; HLA: Human leukocyte antigen; CMV: Cytomegalovirus; PRA: Panel reactive antibody; SKPT: Simultaneous kidney-pancreas transplantation; SPT: Solitary pancreas transplantation; NS: Not significant; NA: Not available; BMI: Body mass index.

Table 4 Outcomes according to pancreas transplantation category

	SKPT	SPT	P value
	n = 162 in 161 patients1	n = 40 in 38 patients1
Patient survival	133/154 (86.4%)	33/38 (86.8%)	NS
Kidney graft survival	120 (74.1%)	28/35 (80%)	NS
Pancreas graft survival	106 (65.4%)	26 (65%)	NS
Follow-up (mo)	68.7 ± 96	92.1 ± 37	NS
Early thrombosis	14 (8.6%)	2 (5%)	NS
Acute rejection	47 (29.0%)	11 (27.5%)	NS
Death in first 4 yr post-transplant	10 (6.2%)	0	NS
Death with functioning grafts	15 (9.3%)	0	0.007

¹One patient had 2 SKPTs, two had 2 SPTs, and seven had SKPT followed by SPT. SKPT: Simultaneous kidney-pancreas transplantation; SPT: Solitary pancreas transplantation; NS: Not significant.