Outcomes of pancreas transplantation in older diabetic patients

• Published in: BMJ open diabetes research & care Vol. 8; no. 1; p. e000916
• Main Authors: Montagud-Marrahi, Enrique, Molina-Andújar, Alicia, Pané, Adriana, Ramírez-Bajo, Maria José, Amor, Antonio, Esmatjes, Enric, Ferrer, Joana, Musquera, Mireia, Diekmann, Fritz, Ventura-Aguiar, Pedro
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 05.03.2020; BMJ Publishing Group
• Subjects: Diabetes; Immunology; Immunology and Transplantation; Insulin; Kidney diseases; Kidney transplants; Older people; Pancreas; Pancreas transplants; Patients; Statistical analysis; Surgery; Transplants & implants; Veins & arteries; cardiovascular mortality; pancreas transplantation; elderly; kidney transplantation
• ISSN: 2052-4897; 2052-4897
• DOI: 10.1136/bmjdrc-2019-000916

ObjectiveImprovement 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 methodsWe 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.ResultsThirty-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.ConclusionsLong-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.