Pancreas Transplantation in Black, Asian and Minority Ethnic Patients-Single Centre Experience in the UK

Abstract

Ethnic disparities in the outcomes after simultaneous pancreas kidney (SPK) transplantation still exist. The influence of ethnicity on the outcomes of pancreas transplantation in the UK has not been reported and hence we aimed to investigate our cohort. A retrospective analysis of all pancreas transplant recipients (n = 171; Caucasians = 118/Black Asian Ethnic Minorities, BAME = 53) from 2006 to 2020 was done. The median follow-up was 80 months. Patient & pancreas graft survival, rejection rate, steroid free maintenance rate, HbA1c, weight gain, and the incidence of secondary diabetic complications post-transplant were compared between the groups. p < 0.003 was considered significant (corrected for multiple hypothesis testing). Immunosuppression consisted of alemtuzumab induction and steroid free maintenance with tacrolimus and mycophenolate mofetil. Pancreas graft & patient survival were equivalent in both the groups. BAME recipients had a higher prevalence of type-2 diabetes mellitus pre-transplant (BAME = 30.19% vs. Caucasians = 0.85%, p < 0.0001), and waited for a similar time to transplantation once waitlisted, although pre-emptive SPK transplantation rate was higher for Caucasian recipients (Caucasians = 78.5% vs. BAME = 0.85%, p < 0.0001). Despite equivalent rejections & steroid usage, BAME recipients gained more weight (BAME = 7.7% vs. Caucasians = 1.8%, p = 0.001), but had similar HbA1c (functioning grafts) at 3-,12-, 36-, and 60-months post-transplant.

Favorable outcomes in Hispanic recipients receiving simultaneous pancreas kidney transplantation

“…There was no significant difference in the rates of clinical rejection within the first 2 years for the pancreas or kidneys between Hispanics and whites. These rates were lower than the previously reported rate of approximately 20% for pancreas rejection within the first year in a similar immunosuppression regimen study conducted in Britain that used alemtuzumab induction and steroid‐free maintenance with tacrolimus and mycophenolate mofetil 38 . Our lower rates of clinical rejection may be attributed to the early detection and treatment of subclinical rejection 22 …”

“…These rates were lower than the previously reported rate of approximately 20% for pancreas rejection within the first year in a similar immunosuppression regimen study conducted in Britain that used alemtuzumab induction and steroid-free maintenance with tacrolimus and mycophenolate mofetil. 38 Our lower rates of clinical rejection may be attributed to the early detection and treatment of subclinical rejection. 22 The rates of BKV viremia were similar for Hispanics and whites, including any instance of BKV viremia.…”

A Year of Changes: The End of the Pandemic Marks the Beginning of New Priorities

“…3 But the review article also stressed how donation after cardiac death (DCD) has increased the donor pool for pancreatic transplants. 43 For patients undergoing renal transplants, this year's review focused on preoperative cardiac risk stratification and intraoperative resuscitation, including an RCT, in which Collins et al showed a significantly decreased incidence of delayed graft function with balanced crystalloids compared to normal saline, 44,45 Furthermore, the authors elaborated on regional anesthetic techniques supplementing pain control following renal transplantation. While a meta-analysis showed that transversus abdominis plane blocks significantly reduced postoperative opioid use, 46 quadratus lumborum blocks did not show any significant opioid reduction in a separate RCT.…”

“…3 But the review article also stressed how donation after cardiac death (DCD) has increased the donor pool for pancreatic transplants. 43…”

Hyperglycaemia following a simultaneous pancreas and kidney transplant

“…1 Weight gain following SPK transplantation, however, is common. 2 Hyperglycaemia may, therefore, also occur due to insulin resistance, or the effect of immunosuppressants such as steroids and calcineurin inhibitors. Recurrent T1D in a transplanted pancreas is rare.…”