Sydney School of Public Health
The University of Sydney
Recipient and pancreas graft survival after simultaneous kidney-pancreas transplantation in Australia and New Zealand: a cohort study 1984-2014
Xi (Alex) Peng1, Patrick J Kelly1, Angela C Webster1,2, on behalf of ANZIPTR and contributors2.
1Sydney School of Public Health, The University of Sydney, Sydney, Australia; 2Centre for Transplant and Renal Research, Westmead Hospital, Sydney, Australia
Introduction: We aimed to evaluate the survival and pancreas graft failure for simultaneous kidney-pancreas recipients (SPK) transplant in Australia and New Zealand (ANZ).
Methods: Data from the Australia and New Zealand Islet and Pancreas Transplant Registry (ANZIPTR) were used to analyse the time to pancreas graft failure and time to death (any cause), since SPK transplant. We included all SPK recipients from 1984 to the end of 2014. Graft failure was defined as the first of either pancreatectomy, return to insulin dependence or death. Recipients were otherwise censored at last known follow-up. Time to graft failure and time to death were summarised using Kaplan-Meier survival curves. We investigated potential risk factors for poor outcome using Cox proportional hazard regression models, and generated Hazard ratios (HR, with 95%CI). We considered recipient year of transplant, sex, age, BMI, comorbidity (chronic lung disease, coronary artery disease, peripheral vascular disease, cerebrovascular disease), time since starting renal replacement therapy, and donor factors age and BMI.
Results: There were 627 SPK transplants from 1984 to 2014. The maximum follow-up time was 26.9 years, with a total of 5370 years of observation. Over this period there were 119 (19%) deaths and 214 (34%) pancreas failures (80 of which were due to death). Approximately half (n=331; 53%) of the recipients were male, the average age was 38.7 (SD 7.3) years, average BMI was 24.2 (SD 3.6) kg/m2 , the average number of years on renal replacement therapy prior to SPK transplant was 1.5 (SD 1.9) and 21% had at least one comorbidity. The average donor age was 27.5 (SD 10.0) years, with an average BMI of 24.0 (SD 3.4) kg/m2.
Patient survival was 97% at 1 year, 93% at 5 years, 81% at 10 years, 69% at 15 years and 64% at 20 years. Survival has substantially improved since the first SPK transplants in ANZ. After adjusting for all other listed factors, the risk of dying decreased by 48% for patients receiving a SPK transplant in 2010-2014 compared to 1989-1994 (HR=0.52; p<0.01). Recipient age was also associated with death, with a 4% increase in death for every year older at transplantation (HR =1.04; p=0.04). There was no evidence of increased risk of death with any of the other factors (p>0.05).
Pancreas transplant survival was 84% at 1 year, 76% at 5 years, 64% at 10 years, 56% at 15 years and 50% at 20 years. Risk of pancreas failure substantially decreased since the first SPK transplant in ANZ: graft failure decreased 40% between 1989-1994 and 2010-2014 (HR=0.60; p<0.02). However, after adjusting for other potential risk factors, the only factor increasing risk of pancreas failure was donor age: the risk of graft failure increased by 2% for every year the donor is older (HR =1.02; p=0.03). There was some evidence that time on renal replacement therapy (RRT) is also associated with graft failure (p=0.08), with longer RRT associated with higher risk of graft failure.
Conclusion: There has been substantial improvement in patient survival and a substantial reduction in the risk of pancreas failure since SPK first began in ANZ.
We would like to thank ANZIPTR and contributors for providing the data for this study.
11:00 - 12:30
|Progress and clinical outcomes in pancreas transplantation||Recipient and pancreas graft survival after simultaneous kidney-pancreas transplantation in Australia and New Zealand: a cohort study 1984-2014||Room 110|
15:30 - 17:00
|Pancreas & Islet Donors: Assessing Risk and Optimizing Outcomes||Donor characteristics of pancreas transplants in Australia and New Zealand: a cohort study 1984-2014||Room 110|