Impact of duration of diabetes on outcome following pancreas transplantation

Introduction: The 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 methods: A 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. Results: While, 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. Conclusions: Longstanding T1DM does not seem to negatively impact recipient outcomes following all types of pancreas transplantation.