Impact of duration of diabetes on outcome following pancreas transplantation

• Longstanding T1DM does not seem to negatively impact recipient outcomes following all types of pancreas transplantation.
• Duration of diabetes exposure significantly correlates with the need for kidney transplantation.
• The majority of pancreas recipients with longer standing diabetes (21–30 and >30 years) were also undergoing kidney transplantation as SPK or PAK, likely because renal failure is a late complication of diabetes.
• PTA recipients, on the other hand, tended to make up a much larger portion of the group with the shortest duration of diabetes.

IntroductionThe impact of duration of T1DM on outcomes following simultaneous pancreas and kidney transplantation (SPK), pancreas after kidney transplantation (PAK), and pancreas transplantation alone (PTA) is currently unknown.Materials and methodsA total of 451 pancreas transplants performed at a single institution between January 2003 and April 2013 (SPK n = 238, PAK, n = 97, and PTA, n = 116) were divided into three groups based on cumulative years of T1DM (0–20 years, 21–30 years, and >30 years). Early (7-day) and late (90-day) pancreas allograft loss, patient and pancreas allograft survivals were analyzed.ResultsWhile, PAK was more common in recipients with >30 years of T1DM (29%, p < 0.0047), PTA was more common in recipients with 0–20 years of T1DM (41%, p < 0.0011). In all transplant types, recipients age was significantly higher the longer the duration of diabetes. Although longer duration of T1DM correlated with a higher rate of major amputations in PAK recipients (p < 0.0032), no difference was observed in SPK or PTA. While early pancreas graft loss was 2–4% in SPK and PAK with shorter or longer T1DM (p = n.s.), it reached to 10% in PTA with T1DM > 30 years (p < 0.0097). Longer duration of T1DM affected late pancreas graft loss in PAK patients (8%, p < 0.0349). Patient and death-censored graft survival rates were similar in all types of pancreas transplantation extracted by accumulation of years of T1DM prior to transplant.ConclusionsLongstanding T1DM does not seem to negatively impact recipient outcomes following all types of pancreas transplantation.