P-156

Pancreatic re-transplantation outcome compares favorably to primary pancreas transplantation

J. R. Scalea, R. Barth, S. Fayek, J. Bromberg, B. Philosophe, S.T. Bartlett, M. Cooper
University of Maryland, Surgery, Div. of Transplantation, Baltimore, USA

Background: Many patients present for pancreatic re-transplantation (PRetxp) following graft loss. PRetxp outcomes now rival that of primary pancreatic transplantation in select individuals.

Methods: The PRetxp experience at a single institution was evaluated retrospectively, between 1992 and 2011. An historic cohort (1992 -1999) was compared with the contemporary experience (2000 -2011). Outcomes including patient and graft-survival were collected. Student’s t-test was used for statistical analysis.

Results: Seventy-seven patients underwent PRetxp. Mean recipient age at re-transplantation was 40.1 yrs vs 36.8 at primary transplant. Nearly all re-transplants (94.8%) were solitary pancreatic transplants, in contrast to 42% at primary transplantation. HLA-mismatch and cold-ischemia-time was similar (19.9 vs 19.4 hrs); however, donor age was 29.2 yrs for primary grafts vs. 25.6 years for re-transplanted grafts (p=0.08). Ten patients died during the study period, 5 (50%) of which had a functioning graft at the time of death. Mean 1-year graft-survival for re-transplantation was 71.4%, and 5-year graft survival was 60.1%; however, death-censored 5-year graft-survival was 66.1%. Overall graft-survival of primary v. re-transplanted grafts was 4.7yrs. v. 8.08 yrs. (p<0.0001). In our early experience (prior to the year 2000), 15 of 41 re-transplants (37%) were lost in < 1 year, versus only 4 of 32 (12.5%), p=0.01, in our more recent experience (2000-2011). Fifteen grafts were lost due to chronic rejection; 12 of these were prior to the year 2000. Ten patients (12.9%) lost grafts due to thrombosis; eight occurred in the early period, versus only 2 in the late period.

Conclusions: Since 2000, we have observed less thrombosis and improved graft function; highlighting improvements in technical re-transplant and graft surveillance. Although re-transplant donors tend to be utilized for repeat grafts, immunologic graft loss has become less common. PRetxp is effective for patients with recalcitrant diabetes-mellitus, and should be considered for the appropriate patient-population.

P-156

Pancreatic re-transplantation outcome compares favorably to primary pancreas transplantation

J. R. Scalea, R. Barth, S. Fayek, J. Bromberg, B. Philosophe, S.T. Bartlett, M. Cooper
University of Maryland, Surgery, Div. of Transplantation, Baltimore, USA

Background: Many patients present for pancreatic re-transplantation (PRetxp) following graft loss. PRetxp outcomes now rival that of primary pancreatic transplantation in select individuals.

Methods: The PRetxp experience at a single institution was evaluated retrospectively, between 1992 and 2011. An historic cohort (1992 -1999) was compared with the contemporary experience (2000 -2011). Outcomes including patient and graft-survival were collected. Student’s t-test was used for statistical analysis.

Results: Seventy-seven patients underwent PRetxp. Mean recipient age at re-transplantation was 40.1 yrs vs 36.8 at primary transplant. Nearly all re-transplants (94.8%) were solitary pancreatic transplants, in contrast to 42% at primary transplantation. HLA-mismatch and cold-ischemia-time was similar (19.9 vs 19.4 hrs); however, donor age was 29.2 yrs for primary grafts vs. 25.6 years for re-transplanted grafts (p=0.08). Ten patients died during the study period, 5 (50%) of which had a functioning graft at the time of death. Mean 1-year graft-survival for re-transplantation was 71.4%, and 5-year graft survival was 60.1%; however, death-censored 5-year graft-survival was 66.1%. Overall graft-survival of primary v. re-transplanted grafts was 4.7yrs. v. 8.08 yrs. (p<0.0001). In our early experience (prior to the year 2000), 15 of 41 re-transplants (37%) were lost in < 1 year, versus only 4 of 32 (12.5%), p=0.01, in our more recent experience (2000-2011). Fifteen grafts were lost due to chronic rejection; 12 of these were prior to the year 2000. Ten patients (12.9%) lost grafts due to thrombosis; eight occurred in the early period, versus only 2 in the late period.

Conclusions: Since 2000, we have observed less thrombosis and improved graft function; highlighting improvements in technical re-transplant and graft surveillance. Although re-transplant donors tend to be utilized for repeat grafts, immunologic graft loss has become less common. PRetxp is effective for patients with recalcitrant diabetes-mellitus, and should be considered for the appropriate patient-population.