Study: Higher Risk Tied to Solitary Pancreas Transplant

Diabetics who receive a solitary pancreas transplant have a "significantly worse" prospect for survival than those in similar shape who stick with insulin injections, according to a report in the Journal of the American Medical Association.

But the increased risk of death applies only to diabetics who receive just a pancreas transplant, and not those who receive a simultaneous kidney-pancreas transplant, the government researchers reported.

The researchers used data compiled between 1995 and 2000 on 11,572 diabetic patients who were on the waiting list for a pancreas transplant at 124 U.S. transplant centers. During this period, about half of the patients underwent transplantation, usually simultaneous pancreas-kidney transplantation.

Patients who received pancreas-only transplants had a one-year survival rate of 97 percent and a four-year survival rate of 85 percent, compared with 98 percent and 92 percent for those who tried to control their diabetes by conventional means while awaiting a transplant.

The prognosis was only slightly better for patients who received pancreas transplants at some point after receiving a kidney transplant.

In contrast, patients who received simultaneous kidney-pancreas transplants had a reduced risk of death.

The results suggest that "the enthusiasm for simultaneous pancreas-kidney transplantation is probably justified," Dr. David M. Nathan, of Harvard Medical School in Boston wrote in an accompanying editorial.

But the researchers said data from the study suggests " that patients with complicated diabetes who are considering a solitary pancreas transplant must weigh the potential benefit of insulin independence against an apparent increase in mortality for at least the first 4 years posttransplantation.

"Benefits not accounted for in this analysis (e.g., improved quality of life) may justify pancreas transplantation, and it is possible that transplant recipients may show a survival advantage with longer-term follow-up." the researchers said. "Even if that is true, however, it is at best difficult to weigh the cost of an early excess mortality (spanning the first 4 years posttransplant) against what at this point is a hypothetical survival advantage beyond the 4 years we have analyzed.

"At this point, clinicians and patients considering the pancreas transplant option must understand the actual risks and benefits, the expense, and the uncertainties associated with this surgical therapy. Our data suggest that the increasingly frequent application of the solitary pancreas transplantation option for those with normal kidney function warrants a second look," they concluded.

Other Sources: Journal of the American Medical Association