CHAPTER 102: Epidemiology—Pancreas Transplantation

ORGAN PROCUREMENT AND TRANSPLANTATION NETWORK (OPTN) AND SCIENTIFIC REGISTRY OF TRANSPLANT RECIPIENTS (SRTR) DATA^1,2,3

• Data from:

  • https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/#.

  • Kandaswamy R, Stock PG, Gustafson SK, Skeans MA, Urban R, Fox A, Israni AK, Snyder JJ, Kasiske BL. OPTN/SRTR 2018 Annual Data Report: Pancreas. Am J Transplant. 2020 Jan;20 Suppl s1:131-192. doi: 10.1111/ajt.15673. PMID: 31898415.

  • Kandaswamy R, Stock PG, Miller J, Skeans MA, White J, Wainright J, Kyaw NTT, Niederhaus S, Israni AK, Snyder JJ. OPTN/SRTR 2019 Annual Data Report: Pancreas. Am J Transplant. 2021 Feb;21 Suppl 2:138-207. doi: 10.1111/ajt.16496. PMID: 33595197.

WAIT LIST^1,2,3

• Current wait list candidates:

• Current wait list candidates:

  • ~900 pancreas

• Isolated pancreas/simultaneous kidney-pancreas transplants recorded by HRSA since 1988:

  • 24/48 from live donors

  • ~9,000/~25,500 deceased donors

• Intended transplant type:

  • SPK 77% (increasing over the past years)

  • PTA 13% (decreasing over the past years)

  • PAK 10% (decreasing over the past years)

• Re-transplants ~5% (decreasing and consistent with decreasing PTA)

• Age:

  • ~25% age 18–34

  • ~60% of candidates 35–54 years of age

  • ~10% age >55

• Sex distribution

  • Males ~54%

  • Females ~46%

• Ethnicity:

  • Whites ~55% (decreasing over the past decade)

  • Blacks ~25% (increasing over the past decade)

  • Hispanics ~15% (increasing over the past decade)

• Diagnosis:

  • ~75% type 1 diabetes mellitus

  • 17% type 2 diabetes mellitus

• BMI:

  • Increasing proportions of higher BMI

  • ~40% BMI 18.5–< 25 kg/m²

  • ~40% BMI 25–<30 kg/m²

  • ~20% BMI 30–<35 kg/m²

• Time on wait list:

  • ~50% <90 days

  • ~20% >2 years

  • ~10% 6–<12 months

• 5 deaths per 100 patient years overall mortality rate among waitlisted adults

• Median time to transplant:

  • SPK: 12.0 months

  • PTA: 24.1 months

  • PAK: not calculated

DONATION^1,2,3

• Live donors

  • There have been no live pancreas donors in the United States since 2014.

    • There was only 1 live donor in 2013, only 1 in 2008, and only 1 in 2006.

  • Still prevalent in parts of Asia.

• Deceased donors:

  • Age:

    • ~50% were 18–29 years of age

    • ~20% were <18 years old.

    • ~25% were 35–39 years old.

  • Sex:

    • 70% male

    • 30% female

  • Race:

    • 60% white

    • 20% Black

    • 15% Hispanic

  • Cause of death:

    • Head trauma ~50% (decreasing incidence)

    • Anoxia ~40% (increasing incidence)

    • CVA/stroke ~10%

  • Discard rate (pancreases recovered but not transplanted)

    • 25% overall

    • ~20% from donors with BMI 18.5-<25 kg/m²

    • ~20% from donors 18-29 years of age

  • Average PDRI(Pancreas Donor Risk Index): 1.06–1.09

TRANSPLANTS^1,2,3

• ~1,000 pancreas transplants / year

  • SPK ~85%

  • PAK ~10%

  • PTA ~5%

• Sex:

  • Males 60%

  • Females 40%

• Age groups:

  • Most recipients in age group 35–54 (60%)

  • Followed by 18–34 (~20%)

• Race:

  • Although Whites represent the greatest component (~50%), its number is decreasing

  • Increasing number of Black recipients (~30%)

• Diagnosis:

  • 75% type 1 diabetes

  • 20% type 2 diabetes

• Induction immunosuppression:

  • T-cell depleting agent: 90%

• Immunosuppression regimen:

  • Tacrolimus + mycophenolic compound + steroids: ~65%

  • Tacrolimus + mycophenolic compound: ~30%

  • TOR inhibitors not frequently used (~3%)

• CPRA at time of ...