Lessons from a 13 Year Cohort of the First UK Pancreas Transplant Programme

Introduction: The aim of this study was to review the 13 years activity of the first solid pancreas transplant programme in the UK with particular emphasis on the donor and recipient factors influencing early pancreatic graft loss. Methods: Recipient and donor details, patient, graft survival and follow-up data for all pancreas transplants performed were prospectively extracted from the local database, electronic medical records, and the NHS Blood and Transplant database. Results: From April 2000 until April 2013 433 patients were assessed for pancreas transplantation, 231 patients were registered on the transplant waiting list and 171 patients were transplanted [160 simultaneous pancreas-kidney (SPK), 7 pancreas after kidney transplants (PAK) and 4 pancreas transplants alone (PTA)]. There were 5 technical failures (2.9%); in addition there were 21 early pancreatic graft losses (12%) and 8 late pancreatic graft losses (4.6%). Patient survival at 1, 3 and 5 years was 97%, 92% and 89%; SPK graft survival 82%, 81%, and 81%, PTA / PAK graft 60%, 50% and 50% respectively. The incidence of rejection episodes in the first 3 months was 10.5 %. 28% required laporotomy, 48% were due to bleeding although overall graft loss due to bleeding was 4%. Multivariate analysis showed that recipient age and donor age have independent prognostic value for early pancreatic graft loss ( P < 0.05). Conclusions: The long term survival in our programme is favourable but patients had a higher risk of bleeding complications. The donor and recipient age impact on graft survival, whilst pre-existent cardiovascular comorbidity does not preclude a successful transplant.