An analysis of pancreas transplantation outcomes based on age groupings – an update of the <scp>UNOS</scp> database

Siskind, E. J.; Maloney, Caroline; Akerman, Meredith; Alex, Asha; Ashburn, Sarah; Barlow, Meade; Siskind, Tamar; Bhaskaran, Madhu; Ali, Nicole; Basu, Amit; Molmenti, Ernesto P.; Ortíz, Jorge

doi:10.1111/ctr.12407

Cited by 38 publications

(60 citation statements)

References 19 publications

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“…We found death‐censored pancreas and kidney graft survival to be equivalent to outcomes in younger recipients. In other solid organ transplantation, death‐censored graft survival has been noted to be equivalent in older recipients , whereas in pancreas transplantation a previous UNOS database analysis suggested that optimal graft survival is seen in those aged 40–49 years with poorer graft survival in older age groups . However, single‐centre studies have not demonstrated any difference in graft outcomes between older and younger recipients.…”

Section: Discussionmentioning

confidence: 99%

An analysis of the association between older recipient age and outcomes after whole‐organ pancreas transplantation – a single‐centre, retrospective study

Mittal

Smilevska²,

Franklin

et al. 2020

Transpl Int

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Summary Older people are increasingly being referred for consideration for pancreas transplantation (PT). We investigated the outcomes after PT in our older recipient cohort. A prospectively maintained database was interrogated. The cohort was analysed for associations between outcome and older recipient age. A total of 444 transplants were performed in patients aged 23–54 years and 83 transplants in patients aged 55–67 years. There was no difference in death‐censored pancreas or kidney graft survival between the groups. Patient death was associated with older recipient age (HR 1.63 per 10‐year increase). In multivariate Cox regression, risk of mortality was also associated with post‐transplant myocardial infarction (HR 7.25, P = 0.006), pancreas failure (HR 1.91, P = 0.003) and kidney failure (HR 3.55, P < 0.001). About 40% of recipients who died in the first year post‐transplant suffered early graft loss. Those alive at a year post‐transplant had inferior survival if they had lost their kidney graft (P < 0.001). Mortality is higher in older patients and is strongly associated with pancreas and kidney graft failure. This suggests that pancreas transplantation is feasible in older recipients, and careful selection of donor organs is important to optimize survival.

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Section: Discussionmentioning

confidence: 99%

An analysis of the association between older recipient age and outcomes after whole‐organ pancreas transplantation – a single‐centre, retrospective study

Mittal

Smilevska²,

Franklin

et al. 2020

Transpl Int

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“…Most recently, in 2014, Siskind et al . published an analysis of more than 20 000 pancreas transplant recipients reported to UNOS. Of these, 3440 patients were over the age of 50.…”

Section: Discussionmentioning

confidence: 99%

“…However, this exclusionary practice has been based on limited data. Some authors have described acceptable outcomes in older patients, whereas others have remained more cautious . However, the risk versus benefit ratio for procedures such as pancreas transplantation can change dramatically over time as outcomes improve and as risk factors, both modifiable and nonmodifiable, become better appreciated .…”

Section: Introductionmentioning

confidence: 99%

Pancreas transplantation in older patients is safe, but patient selection is paramount

et al. 2016

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SUMMARYPancreas transplant outcomes have progressively improved. Despite this, some centers have continued to employ historical age limits for pancreas transplant candidates. We sought to determine the importance of chronological age in determining patient and graft survival rates after pancreas transplantation. A single-center, retrospective study of adult, deceased donor simultaneous pancreas and kidney (SPK) and solitary pancreas transplants (SP, including pancreas transplant alone and pancreas after kidney transplants) in recipients ≥ 55 years (55 + ), occurring between July 1, 1999, and June 30, 2012, was performed. Seven-hundred and forty patients underwent pancreas transplantation, of which 28 patients were 55 + . Patient survival was comparable for younger and older pancreas transplant recipients. Both non-death-censored and death-censored pancreatic graft survival rates were similar in younger and in older patients. Patients aged 45-54 and those aged 55 + had more frequent cardiovascular events than younger pancreas transplant recipients. There was no difference in renal graft survival for SPK patients when compared with diabetic kidney transplant alone recipients aged 55 years and older. Older pancreas transplant recipients had acceptable long-term patient and graft survival rates, although complications may occur. Chronological age alone should not exclude a patient for pancreas transplant candidacy.

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“…This is not the first study on the subject of pancreas transplantation in the elderly; hence, the result is even less surprising. Besides some retrospective single‐centre analyses that came to similar conclusions, a UNOS database review of 20 854 patients exists and includes 3160 patients between 50 and 59 years and 280 over 60‐year old at the time of transplantation . In this register‐based analysis, an increasing patient age correlated with a significant decrease in patient and graft survival, especially in the group aged over 60 years.…”

mentioning

confidence: 91%

The elderly pancreas transplant recipient

Schenker

2016

Transpl Int

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An analysis of pancreas transplantation outcomes based on age groupings – an update of the UNOS database

Abstract: Pancreas transplants performed in patients of increasing age demonstrate decreased patient and graft survival when compared to pancreas transplants in patients <50 yr of age.

Cited by 38 publications

References 19 publications

An analysis of the association between older recipient age and outcomes after whole‐organ pancreas transplantation – a single‐centre, retrospective study

An analysis of the association between older recipient age and outcomes after whole‐organ pancreas transplantation – a single‐centre, retrospective study

Pancreas transplantation in older patients is safe, but patient selection is paramount

The elderly pancreas transplant recipient

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