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Presenter: Y., Kudva, Rochester, USA
Authors: Y. Kudva, A. Parsaik, M. Dong, N. Rostambeigi, W. Kremers, P. Dean, F. Cosio, M. Prieto, M. Stegall
Efficacy of pancreas transplantation: impact on glycemic control, cardiovascular outcomes and survival
Y. Kudva, A. Parsaik, M. Dong, N. Rostambeigi, W. Kremers, P. Dean, F. Cosio, M. Prieto, M. Stegall
Mayo Clinic, Rochester, MN, USA
Objective: To evaluate the efficacy of pancreas transplantation (PT) by measuring it’s impact on severe hypoglycemia (SH), diabetic ketoacidosis (DKA), glycemic control and cardiovascular outcomes.
Methods: 252 patients underwent PT ( simultaneous pancreas-kidney 60, pancreas alone 71, and pancreas after kidney transplants 121) at our institution between 01/01/1998 and 12/31/2009. PT was considered fully functional (FF) if normal C-peptide, HbA1c < 7%, FPG<126mg/dl, and not on any anti-hyperglycemic treatment (AHT); as partially functional (PF) if C-peptide was > 200 pmol/L, and on AHT; and as complete allograft failure (CF) if C-peptide < 200 pmol/L with AHT.
Results: Mean age was 43.9±9 years with 53% males. Median follow up was 6.3 (IQR 3-9) years. At last follow up 168 patients had FF graft, 48 PF, and 36 had CF. The cumulative incidence for PF is 12%, 17%, and 29% at 1, 2, and 5 years. The cumulative incidence for CF is 5%, 7%, and 14% at 1, 2, and 5 years. 8 patients experienced 10 episodes of DKA which differed according to graft failure status (p=0.003) (PF vs FF HR [Hazard Ratio] = 14.5, p=0.036; CF vs FF HR=66.4, p<0.001) after adjusting for age, gender, and transplant type. SH was experienced by 21 patients and differed between graft failure status groups (p<0.001) (PF vs FF HR=95.9, p<0.001; CF vs FF HR=257.3, p<0.001; CF vs PF HR=4.2, p=0.041) after covariate adjustment. Cardiovascular events (CV) occurred in 73 patients and were similar between groups (p=0.160) after covariate adjustment. Adjusted patient survival was different overall according to graft status (p<0.001), but the pair wise differences were only significant between CF and FF (CF vs FF HR=3.95, p<0.001; PF vs FF HR=1.99, p=0.058; CF vs PF HR=1.99, p=0.118).
Conclusion: Fully functioning pancreas allograft significantly decreases the risk of metabolic emergencies.
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