Over 500 pancreas transplants by a single team in São Paulo, Brazil

Abstract

Pancreas transplantation (PT) remains a developing practice in Latin America. From 1996 to 2009, 506 PTs were performed by our team in the following categories: simultaneous pancreas-kidney (SPK), simultaneous deceased donor pancreas and living-donor kidney (SPLK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). Enteric drainage was preferred for SPK and bladder drainage for solitary PT or SPLK. Immunosuppression was with tacrolimus, mycophenolate mofetil, and steroids, and anti-lymphocytic drugs were used to induce solitary PT and SPLK. The series includes 254 SPK, 60 SPLK, 94 PAK, and 98 PTA. The one-yr patient survivals were 82% for SPK, 90% for SPLK, 95% for PTA, and 93% for PAK. The one-yr pancreas graft survivals were 70% for SPK, 86% for SPLK, 86% for PAK, and 77% for PTA. The one-yr kidney graft survivals were 77.5% for SPK and 89% for SPLK. This represents the largest reported PT series in Latin America. Results comparable to those of developed countries were achieved, with the exception of the SPK category. This has led our program to prioritize solitary PT and SPLK.

The IKEM Pancreas and Islet Transplant Program as Part of Healthcare for Type 1 Diabetes Patients: Retrospective Analysis of Outcome from 1983 to 2010

“…One-year cumulative patient survival was 82%. Pancreas and kidney survival rates were 70% and 78% after 1 year, respectively [14].…”

Survival benefit of the homologous kidney allograft in simultaneous pancreas‐kidney transplants and its potential protective role

“…23 Unfortunately, the largest SPLK series in the literature have not been powered enough to demonstrate a survival difference between SPLK and SPK transplants. 24,25 In our series, we examined outcomes between SPK and SPLK transplants and found that SPK pancreata had improved survival and decreased rejection episodes over SPLK pancreata in bivariate and multivariable analyses. Furthermore, SPLK and PAK pancreata still had a survival advantage over PTA pancreata, suggesting that a homologous kidney-pancreas origin may prove advantageous in the combined organ transplant.…”

“…To address the second hypothesis, we explored the observation that SPLK transplants seem to yield a lower pancreas graft survival 23 . Unfortunately, the largest SPLK series in the literature have not been powered enough to demonstrate a survival difference between SPLK and SPK transplants 24,25 . In our series, we examined outcomes between SPK and SPLK transplants and found that SPK pancreata had improved survival and decreased rejection episodes over SPLK pancreata in bivariate and multivariable analyses.…”

Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype

“…Death-censored dual graft loss, ascribed to acute and chronic rejection, was three times more likely in AA (21%) versus Caucasian patients (7%, p = 0.0055). Several single center studies from South America have reported good outcomes in a predominantly Hispanic population, while other studies from China, Korea, India, and Japan have reported excellent outcomes in a predominantly Asian population [48,50,[144][145][146][147][148]. In 1997, the University of Miami group published one of the first reports of successful SPKT in Hispanic recipients with T1DM [144].…”