Long-term pancreas allograft survival in simultaneous pancreas-kidney transplantation by era.

Data collected by UNOS from all approved US transplant programs were analyzed. The analysis was based on data for 22,075 diabetic patients who received a pancreas transplant between January 1995 and December 2011. Simultaneous pancreas-kidney (SPK) transplantation was the major therapeutic option for diabetes patients. SPK had better survival than pancreas transplantation alone (PTA) or pancreas-after-kidney (PAK) transplantation. The 5-year pancreas graft survival rate for SPK, PAK, and PTA was 71.3%, 56.6%, and 53.0%, respectively. When long-term SPK pancreas graft survival was examined by transplant era, there was no survival improvement after 1995. The effect of year of transplant was estimated using Cox proportional hazard models. The 5-year pancreas graft survival rate in the eras 1995-1998, 1999-2002 and 2003-2006 were 69.2%, 69.8%, and 72.4%, respectively. For those whose graft survived over one year, the 5-year graft survival rate in those eras was 83.5%, 83.4%, and 85.2%, respectively. The adjusted hazard ratio for overall graft loss by year of transplant for the grafts that survived more than one year in the eras 1999-2002 and 2003-2006 was 1.08 (95% confidence interval [CI], 0.94-1.24) and 0.95 (95% CI, 0.82-1.11), respectively. The survival rate of long-term pancreas grafts remained almost unchanged over time.

An analysis of intestinal transplant in the United States.

We performed a retrospective analysis of intestinal transplant patients from United States transplant centers using The Organ Procurement and Transplantation Network/United Network of Organ Sharing (OPTN/UNOS) registry. A total of 2164 intestinal transplants were performed in the United States between 1990 and the end of 2011 and were reported to UNOS. Gender, ethnicity, age at transplant, and original disease had little impact on intestinal allograft survival. We found that a shift in the type of transplant operation [intestine alone, intestine plus liver (I+L), or intestine plus liver and pancreas (I+L+P)] away from I+L, starting in 2005, led to better outcomes. Transplants including the stomach had significantly worse graft survival, and often were performed with the I+L+P method. Even though the outcomes of co-transplant of stomach methods, especially the I+L+P method were shown not to be favorable, in reality, the number of patients receiving the operation is still increasing. Despite the overall improvement in graft survival for intestinal transplants over the last 2 decades, within the 2 decades there is a different story. Graft survival after 2005 compared to seven years before 2005 has not improved. Going forward, there is still significant room for improvement in intestinal transplantation. Based on the improvements over the past 2 decades, there is hope that in the next 2 decades, intestinal transplant will reach the success of renal, cardiac, and liver transplantation.

Influence of recipient race on the outcome of simultaneous pancreas and kidney transplantation.

Racial differences on the outcome of simultaneous pancreas and kidney (SPK) transplantation have not been well studied. We compared mortality and graft survival of African Americans (AA) recipients to other racial/ethnic groups (non-AA) using the national data. We studied a total of 6585 adult SPK transplants performed in the United States between January 1, 2000 and December 31, 2007. We performed multivariate logistic regression analyses to determine risk factors associated with early graft failure and immune-mediated late graft loss. We used conditional Kaplan-Meier survival and multivariate Cox regression analyses to estimate late death-censored kidney and pancreas graft failure and death between the groups. Although there was no racial disparity in the first 90 days, AA patients had 38% and 47% higher risk for late death-censored kidney and pancreas graft failure, respectively (p = 0.006 and 0.001). AA patients were twice more likely to lose the kidney and pancreas graft due to rejection (OR 2.31 and 1.86, p = 0.002 and 0.008, respectively). Bladder pancreas drainage was associated with inferior patient survival (HR 1.42, 95% CI 1.15, 1.75, p = 0.001). In the era of modern immunosuppression, AA SPK transplant patients continue to have inferior graft outcome. Additional studies to explore the mechanisms of such racial disparity are warranted.

Relationships between sex, race, and social class and social support networks in kidney, liver, and pancreas transplant recipients.

CONTEXT: The contribution of social support networks to the recovery of transplant recipients is an important assessment in measuring improved physical and psychosocial well-being. Social support networks are described by structure, type, and function. OBJECTIVES: (1) To describe the levels of structure (size, formal and informal support), type (concrete, emotional, and informational), and function (criticalness, direction, closeness, frequency, and duration) of the social support network and (2) to examine the relationships between individual characteristics of sex, race, and social class and social support networks. METHODS: This exploratory-descriptive study was done in a Mid-south transplant center. A total of 258 kidney, liver, and pancreas transplant recipients participated, 61% of whom were less than 50-years-old. Instruments included a demographic questionnaire, the social support network pie chart, and the social support network grid. Descriptive statistics and analysis of variance were used with a .05 significance level. RESULTS: The social support network comprised extended family (67%), with a mean of 13.68 members. Emotional support was the most prevalent type of support reported. The mean (SD) duration of support was 7.9 (4.9) years. Sex, race, and social class had no main relationships with structure and type of support. However, women had a main effect with closeness (F = 4.98, P < .03) and African Americans had significantly higher levels of frequency of support (F = 7.51, P < .01) and longer duration of support (F = 9.07, P < .01) than did whites. Social and nursing intervention may improve the network closeness in males and may also augment support frequency and duration for whites.