Pancreas transplantation in older recipients

A. Rathnasamy Muthusamy¹, S Sinha¹, A. Vaidya¹, I. Quiroga¹, E. Sharples², J. Gilbert¹, S Reddy¹, P.J. Friend^3
1 Oxford Transplant Centre, Transplant Surgery, Oxford, U.K.; ² Oxford Transplant Centre, Transplant Nephrology, Oxford, U.K.; ³ University of Oxford, Oxford, U.K.

Objective: Improving outcomes resulted in pancreas transplantation being offeredto older recipients. We investigated if this expansion was associated withadverse outcome.

Methods: Between March 2004 & February 2011, 407 pancreas transplants (353DBD, 54 DCD) were performed. All grafts were implanted intraperitoneally withenteric - caval drainage. 95% received Alemtuzumab induction. Morbidity, graft and patient andoutcomes were compared between older (OR) and younger recipients (YR).

Results: Within 407 transplants, 86 recipients (21%) were ≥ 50 years old attransplant; 321 recipients were <50 yrs. Of the 86 recipients in the ORgroup, 50 (58%) were aged 50-54 yrs, 27 (31%) were aged 55-59 and 9 (11%) were ≥ 60 yrs (max 67 yrs). ORhad 16% grafts from DCD; YR had 12% (p=0.3). OR had 64 SPK, 12 PTA and 10 PAK,whereas YR had 236 SPK, 38 PAK and 47 PTA. OR donors’ median age was higher(43, range 5-63) than YR median donor age (36, range 15-63) (p=0.0002) reflectingattempts to match donor-recipient age. Both groups had 35-month median followup (range 1-84). Actuarial patient (91% YR vs. 93% OR), pancreas (83% vs. 83%),and kidney graft survival (89% YR vs. 88% OR) was similar. Both groups hadsimilar DGF of the kidney (14% YR vs. 23% OR, p=0.09) and of the pancreas (4%YR vs. 3% OR). Rejection occurred in similar frequency – 11% YR vs. 9% OR,p=NS. Readmission (27% YR vs. 24% OR), reoperation (23% YR vs. 27% OR, p=0.3),and peri-operative cardiac events (5% YR vs. 2% OR, p=0.3) were similar. Bacterial(5.3 vs. 5.8%), viral (7% vs. 8%) and fungal (1% vs. 3%) infections’ incidencewas similar.

Conclusion: Offering pancreastransplantation to older recipients appears to be safe with similar graft &patient survival and comparable morbidity.