Pancreas Transplantation: A review of 34 patients between ...



Pancreas Transplantation: A review of 34 patients between April 2000 and January 2004

C Jansen, IM Pope, JJ Casey, M Akyol

Introduction: Outcome of pancreas transplantation in the UK is unknown. A review of the Scottish Pancreas transplant programme since its inception in Edinburgh is presented.

Results: Between April 2000 and January 2004 34 pancreas transplants were performed (30 SPK, 2 PAK, 2 PTA). 16 patients were female and the mean age at the time of transplant was 44 (range 9 – 48 years). The waiting time to transplantation ranged between 1 – 577 days (median 117). One-year patient, kidney, and pancreas graft survival rates are 94%, 91% and 78%. All patients received routine immunosuppression; Tacrolimus, Prednisolone and MMF with 5 patients receiving Basiliximab at time of transplant. 26 patients remain insulin independent with a mean HbA1c of 5.4% after a follow-up of 45 months (median range 0 – 45). 29 patients remain dialysis free with a mean creatinine of 112 mmol/l. 8 pancreas graft failures occurred day 1 to 29 due to fistula, arterial thrombosis, duodenal breakdown and haemorrhage. 2 patients died within the first 41 days and one further patient died 36 months post transplant.

Conclusion: Outcome comparable to internationally published data has been achieved in a newly established transplant programme.

Kath Brown 1, Gary Campbell 1, Jamie Traynor 1, Ian Galbraith 2, Keith Simpson 3, Karen Newbigging 4, Donna Wallace 5, David Deardon 1, Colin Geddes 1

1. Renal Unit Western Infirmary 2. Tissue typing Lab Glasgow Royal Infirmary 3. Renal Unit Glasgow Royal Infirmary 4. Renal Unit Dumfries Royal Infirmary 5. Renal Unit Monklands Hospital

Analysis of potential living kidney donors who do not subsequently donate.

Improved access to kidney transplant may be achieved by increasing resources to facilitate living kidney donation. There is limited published information to quantify the investigation of potential living donors (PLD) and the reasons for PLD drop-out

The LDT process in our centres involves several steps before transplant: 1) inform PLD and screen for history of known contraindications; 2) establish blood group compatibility; 3) preliminary lymphocyte cross-match; 4) screening blood tests, electrocardiogram, chest radiograph, creatinine clearance, urine protein excretion, nephrologist review; 5) MRA renal arteries, glomerular filtration rate, review by independent physician; 6) transplant surgeon review and final lymphocyte cross match. The PLD proceeds to the next stage if the preceding stages are satisfactory.

The aim of the present study was to examine blood group compatible potential LDT who had a preliminary lymphocyte crossmatch (stage 3) in the 2 years between April 2001 and March 2003 to determine the number of PLD reaching each stage, the number of actual transplants achieved and identify the reasons for PLD drop-out.

149 PLD to 111 potential recipients (PR) reached the stage of having a preliminary lymphocyte cross match (1-3 PLD per PR). 105 PLD reached stage 4; 60 reached stage 5; 41 reached stage 6; 29 PLD in this cohort have donated a kidney, 3 have firm arrangements for LDT in the near future and 5 will probably donate at a suitable time in the future.

The commonest reasons for PLD drop-out were: donor medical issues (n=31), donor or PR withdrew voluntarily (n=23), positive lymphocyte crossmatch (n=17) and other suitable PLD (n=14). 10 PR received a cadaveric transplant and 5 PR died during the PLD investigation.

These data show that when allocating resources to increase the number of LDT it must be acknowledged that only 24% of PLD that are investigated will subsequently donate. The reasons for PLD drop-out deserve further study.

Randomised study comparing cyclosporin with azathioprine one year after renal transplantation- 15 year outcome

N Joss on behalf of the Glasgow Transplant group. Renal Unit, Western Infirmary, Glasgow, Scotland

The introduction of cyclosporin (CsA) has improved the 1-year graft survival and reduced the incidence of acute rejection episodes after renal transplantation. CsA is associated with many side effects including hypertension and nephrotoxicity. Reducing the exposure of this drug after the first year may be beneficial on patient and graft survival. 216 patients were enrolled in a single centre study. After 1 year, if serum creatinine was less than 300μmol/l and there were no acute rejection episodes in the previous 6 months, the patients were randomised to continue cyclosporin (114) or to be converted to azathioprine (102). Analyses were performed on an intention to treat basis and we present follow up data at 15 years post transplant.

The patients were well matched at baseline There was no difference in patient survival at 15 years, 64.3% in the CsA group and 64.4% in the Aza group. Fifteen-year transplant survival (including death with a functioning graft) was 40% for the CsA group and 47.2% for the Aza group (p=0.7). Fifteen year graft survival censoring for death with a functioning graft was 57% in the CsA group and 72% in the Aza group (p=0.5). The graft survival for the patients who remained on their assigned treatment was higher in the Aza group (87%) compared to 65% in the CsA group, although this was not significant (p=0.1). The median (range) cyclosporin dose was 3 (1.4-7.1) mg/kg at randomisation and was 2.6 (1.8-3.9) mg/kg in the patients who remained on cyclosporin at 15 years.

The estimated glomerular filtration rate (EGFR) at year 2, 5 and 10 was significantly lower in the CsA group; however, by 15 years this effect was lost. In the CsA group systolic blood pressure (SBP) was significantly higher at year 5 and 10 and more patients were on antihypertensive agents. Cox regression analysis was performed to determine which factors predicted death and graft failure. EGFR at year 1 (p=0.003, RR 0.97) and age (p=0.003, RR 0.97) predicted graft survival (censoring for death). Age (p ................
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