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Presenter: A., Farney, Winston-Salem, USA
Authors: A. Farney, J. Rogers, S. Al-geizawi, S. Iskandar, R. Stratta
Long-term outcomes of solitary pancreas transplantation: Do surveillance pancreas biopsies level the playing field?
A. Farney, J. Rogers, S. Al-geizawi, S. Iskandar, R. Stratta
Wake Forest Univ School of Medicine, General Surgery, Winston-Salem, NC, USA
We sought to determine the impact of surveillance pancreas biopsies (SPbxs) on long-term outcomes of solitary pancreas transplants (SPT).
Methods: Single center retrospective analysis of all SPT and simultaneous kidney-PTs (SKPT) performed with antibody induction, FK, MMF, and steroids. Following SPT, SPbxs were performed at 3 week intervals until there were 2 consecutive normal biopsies (bxs). Acute rejection (AR) grade I bxs were treated with steroids ± antibody with follow-up (f/u) bxs every 3 weeks until inflammation resolved. Clinical bxs were prompted by biochemical parameters.
Results: 35 SPT (32 PAK, 3 PA) and 122 SKPTs were performed with a mean f/u of 5±2.5 years. 26 (74%) SPT underwent at least 1 SPbx (mean 2±0.9 bxs/graft). 9 pancreas grafts (PG) were not bx'd due to early thrombosis, infection, or other reasons. Of the 26 PG bx'd, 12 (34%) had some inflammation (>grade indeterminate) detected and 9 (26%) had at least 1 bx with AR>grade I. 8 of 9 (89%) AR>grade I episodes were subclinical. Demographics for SPT vs SKPT were mostly comparable; however, the SPT group had fewer HLA mismatches (SPT 3±1.3, SKPT 4.5±1.3, P<0.001), younger donors (SPT 22±7.6, SKPT 28±12 yrs, P=0.004), and fewer black recipients (SPT 5.7%, SKPT 20%, P=0.04).
Pancreas Graft Survival |
Patient Survival |
||||||
1 yr |
3 yrs |
5 yrs |
1 yr |
3 yrs |
5 yrs |
||
SPT |
92% |
83% |
75% |
100% |
100% |
95% |
|
SKPT |
87% |
80% |
74% |
97% |
94% |
93% |
|
P=0.71 |
P=0.29 |
Causes of PG loss were comparable between SPT and SKPT. Cumulative clinical AR rates were similar between groups (SPT 26%, SKPT 29%, P=0.7).
Conclusions: There is a significant incidence of early subclinical AR in SPT. Antibody induction, HLA matching, careful PG selection, and SPbxs in SPT with treatment of early subclinical AR episodes yield excellent long-term PG survival rates that are equivalent to those in SKPT.
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