Long-term results of pancreas transplantation in patients older than 50 years

Abstract

Summary Aging of the population and improvements in diabetes therapy have led to an increased number of older pancreas transplant candidates. The aim of our retrospective study was to evaluate pancreas transplantation (PT) outcomes in patients ≥50 years, as limited data exist in these patients. We analyzed 398 consecutive pancreas transplant patients from June 1994 to June 2009 for different outcomes (patient/graft survival, rejection rate, and surgical complications) between the age groups ≥50 years (n = 69) and <50 years (n = 329). Donor and recipient characteristics were similar except for recipient age (54.0 vs. 38.8 years), BMI (24.6 vs. 22.9 kg/m2), and duration of diabetes mellitus (36.0 vs. 27.7 years). One‐, 5‐, and 10‐year patient and graft (kidney/pancreas) survival were not significantly different between the groups with patient survival rates reaching 84% and pancreas graft survival up to 67% after 10 years. Surgical complications such as relaparotomy rate (34% vs. 33%) or pancreas graft thrombosis (14% vs. 11%) as well as 1‐year rejection rates (35% vs. 31%) were not significantly different. PT in selected patients aged ≥50 years resulted in survival comparable with that of younger patients. In conclusion, advanced age should no longer be considered as an exclusion criterion for PT. However, good medical assessment and careful patient selection are necessary.

Pancreas Transplantation of Non-Traditional Recipients

“…Similar data exist among DDRT recipients, where the oldest recipients have the worst overall survival, but death-censored graft survival improves linearly with recipient age, suggesting either a beneficial immunosuppressive function of age or more aggressive disease in younger patients [46]. Regardless of mechanism, several other small retrospective institutional studies support the conclusion that recipient age is not a primary risk factor for patient mortality or graft failure and that PT in appropriately selected recipients >50 years of age still holds benefits [47,48].…”

Pancreas Transplantation: Does Age Increase Morbidity?

“…Improvements in the physician's armamentarium to reduce the development of diabetic complications have lead to the emergence of a healthier aging population of type 1 diabetics in need of pancreas transplantation [1, 2]. Progress in surgical techniques, critical care, and immunosuppressive medications have also expanded the pool of transplant candidates to include a significant proportion of patients over the age of 50 [3].…”

Results of Pancreas Transplantation Alone with Special Attention to Native Kidney Function and Proteinuria in Type 1 Diabetes Patients

“…This procedure may be considered as a group of three separate clinical entities: simultaneous pancreas and kidney transplantation (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA) [1][2][3]. It has been shown that SPK, by inducing insulin independence and replacing native renal function, has beneficial effects on diabetes complications and prolongs life expectancy [1][2][3][4][5][6][7][8][9][10].…”