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Presenter: A.J., Hudson, Bristol, United Kingdom
Authors: A.J. Hudson, L.L. Mumford, R.J. Johnson, S.V. Fuggle, C.J.E. Watson
Pancreas Transplantation: A UK and US Comparison
A.J. Hudson1, L.L. Mumford1, R.J. Johnson1, S.V. Fuggle1, C.J.E. Watson2
1 NHS Blood and Transplant, Statistics and Clinical Audit, Bristol, U.K.; 2 Cambridge Transplant Unit, Addenbrooke's Hospital, Cambridge, U.K.
Objectives: UK Pancreas transplantation has been nationally commissioned since 2004. We were interested to benchmark the performance of the new UK pancreas transplant programme against the more established and sizable transplant programme of the USA.
Methods: Data were obtained from the UK Transplant Registry and the US Organ Procurement and Transplant Network. Patients listed, transplanted and transplant outcomes for the two countries were compared. Outcome data included vascularised pancreas transplants performed in 2004 to 2007 (UK: n=512, US: n=3568).
Results: In 2009, UK activity totalled 380 pancreas retrievals (US: 1475), 197 transplants (US: 1049) with around 320 patients waiting (US: 3500). A number of similarities in those transplanted were found: sex (~60% male); recipient age (mean 41 years); highly sensitised patients (approx. 2% with cRF% 80% or more); and proportion on dialysis at listing (approx. 50%). Differences in those transplanted were also apparent: in the UK patients waited fewer days (median 125 v 241 days); 50% were male (US: 68%); donors were older (mean 34 v 22 years)with lower BMI; fewer CMV positive donors (42% v 62%); fewer ‘locally’ used organs (23% v 77%); fewer pancreas-only grafts (13% v 30%) and better HLA matching (37% v 56% with 5/6 total HLA A, B, DR mismatches).The duration of cold ischaemia was similar (mean 13.2 hours UK, 12.7 hours US).
Two independent risk-adjusted Cox-regression models for death censored-graft survival were used to compare factors that influence post-transplant survival in both the UK and US. Factors detrimental in both models were:
graft type (pancreas-only, p<0.05);
increasing donor age (p<0.05);
ischaemia time (p<0.001).
In the longer-term grafts that were poorly HLA-matched fared worse (RR=1.16, p<0.05).
Summary: UK outcomes have improved significantly over the last seven years and more recently pancreas graft and patient survival are similar with outcomes achieved in the US.
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