Where Have All the Pancreas Transplants Gone and What Needs to Change?
- 11 Downloads
Purpose of Review
To shed light on the multiple factors impacting a decline in pancreas transplant volume and to present strategies that individual transplant centers can implement to increase their volumes.
Overall, pancreas transplant volume is declining in the USA and in several other countries of the world. The reasons are multifactorial, but an important driving factor is the delayed progression to end-stage renal disease in patients with type 1 diabetes due to better diabetes care. Another factor contributing to the lack of expansion of the pancreas transplant field is an under appreciation by the endocrinology and medical communities that pancreas transplantation offers excellent results that are now substantially improved over historic outcomes. Compounding these trends, there appears to be a continual negative cycle of low volume at many training centers leading to inadequate training, which then results in a lack of confidence and expertise in practicing surgical faculty and inpatient transplant units.
Of all types of solid organ transplants, pancreas transplantation is unique in that as outcomes have improved over the last several decades, the number of pancreas transplants performed is declining. We discuss the reasons underlying the declining numbers and will highlight specific strategies that can be implemented at centers to increase individual pancreas transplant center volumes.
KeywordsPancreas transplantation Outcomes Diabetes End-stage renal disease Diabetic nephropathy Trends
We would like to express our sincere gratitude to Read Urban and Sharon Shepard of UNOS for providing data related to pancreas program reviews.
Compliance with Ethical Standards
Conflict of Interest
Jon Odorico, Matthew Cooper and Ty Dunn declare no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.• Gruessner AC, Gruessner RWG. Pancreas Transplantation for Patients with Type 1 and Type 2 Diabetes Mellitus in the United States: A Registry Report. Gastroenterol Clin N Am. 2018;47:417–41. https://doi.org/10.1016/j.gtc.2018.01.009. Recent registry report update of US pancreas transplant statistics. CrossRefGoogle Scholar
- 6.Gruessner AC, Laftavi MR, Pankewycz O, Gruessner RWG. Simultaneous Pancreas and Kidney Transplantation-Is It a Treatment Option for Patients With Type 2 Diabetes Mellitus? An Analysis of the International Pancreas Transplant Registry. Curr Diabetes Rep. 2017;17:44. https://doi.org/10.1007/s11892-017-0864-5.CrossRefGoogle Scholar
- 8.Gruessner AC, Gruessner RW. Declining numbers of pancreas transplantations but significant improvements in outcome. Transplant Proc. 2014;46:1936–7. https://doi.org/10.1016/j.transproceed.2014.06.045.CrossRefPubMedGoogle Scholar
- 9.•• Stratta RJ, Gruessner AC, Odorico JS, Fridell JA, Gruessner RW. Pancreas Transplantation: An Alarming Crisis in Confidence. Am J Transplant. 2016;16:2556–62. https://doi.org/10.1111/ajt.13890. Important report documenting the decline in pancreas transplant volumes in the US and the underlying reasons for this negative trend. CrossRefPubMedGoogle Scholar
- 10.• Stratta RJ, Fridell JA, Gruessner AC, Odorico JS, Gruessner RW. Pancreas transplantation: a decade of decline. Curr Opin Organ Transplant. 2016;21:386–92. https://doi.org/10.1097/mot.0000000000000319. Similar to reference 9, this summary report provides insights about the reasons contributing to the decline in pancreas transplant volume in the US. CrossRefPubMedGoogle Scholar
- 11.•• Abrams P, Cooper M, Odorico JS. The road less traveled: how to grow a pancreas transplant program. Curr Opin Organ Transplant. 2018;23:440–7. https://doi.org/10.1097/mot.0000000000000556. The first report providing examples and recommendations for individual transplant centers to implement to enhance their pancreas transplant programs. CrossRefPubMedGoogle Scholar
- 12.Global Observatory on Donation and Transplantation. www.transplant-observatory.org. Accessed 20 June 2019.
- 13.• Kandaswamy R, et al. OPTN/SRTR 2017 Annual Data Report: Pancreas. Am J Transplant. 2019;19(Suppl 2):124–83. https://doi.org/10.1111/ajt.15275. The most recent SRTR report on the status of pancreas transplantation in the US. This report identifies several important trends in the field. CrossRefPubMedGoogle Scholar
- 14.•• Alhamad T, et al. Transplant Center Volume and the Risk of Pancreas Allograft Failure. Transplantation. 2017;101:2757–64. https://doi.org/10.1097/tp.0000000000001628. This study using SRTR data demonstrates the direct relationship between volume and outcomes. It also finds that higher volume programs have excellent outcomes using higher PDRI pancreata. CrossRefPubMedGoogle Scholar
- 16.Serrano OK, Vock DM, Dunn TB, Kandaswamy R, Finger EB. Maximizing Utilization in Pancreas Transplantation: Phenotypic Characteristics Differentiating Aggressive From Nonaggressive Transplant Centers. Transplantation. 2018;102:2108–19. https://doi.org/10.1097/tp.0000000000002334.CrossRefPubMedGoogle Scholar
- 18.UNOS/OPTN. www.unos.org. Accessed June 2019.
- 19.Skupien J, Smiles AM, Valo E, Ahluwalia TS, Gyorgy B, Sandholm N, et al. Variations in Risk of End-Stage Renal Disease and Risk of Mortality in an International Study of Patients With Type 1 Diabetes and Advanced Nephropathy. Diabetes Care. 2019;42:93–101. https://doi.org/10.2337/dc18-1369.CrossRefPubMedGoogle Scholar
- 27.Toppe C, Möllsten A, Waernbaum I, Schön S, Gudbjörnsdottir S, Landin-Olsson M, et al. Decreasing Cumulative Incidence of End-Stage Renal Disease in Young Patients With Type 1 Diabetes in Sweden: A 38-Year Prospective Nationwide Study. Diabetes Care. 2019;42:27–31. https://doi.org/10.2337/dc18-1276.CrossRefPubMedGoogle Scholar
- 32.Narres M, Claessen H, Droste S, Kvitkina T, Koch M, Kuss O, et al. The Incidence of End-Stage Renal Disease in the Diabetic (Compared to the Non-Diabetic) Population: A Systematic Review. PLoS One. 2016;11:e0147329. https://doi.org/10.1371/journal.pone.0147329.CrossRefPubMedPubMedCentralGoogle Scholar