Pancreas transplantation improves the survival of type 1 diabetic patients with end-stage renal failure – An Analysis of the Japanese Pancreas Transplants Registry
Taihei Ito1, Takashi Kenmochi1, Naohiro Aida1, Hajime Matsushima1, Kei Kurihara1, Takuma Ishihara2, Ayumi Shintani3, Tadafumi Asaoka4, Toshinori Ito4.
1Department of Transplantation and Regenerative Medicine, Fujita Health University, School of Medicin, Aichi, Japan; 2Innovative and Clinical Research Promotion Center, Gifu University, Gifu, Japan; 3Department of Medical Statistics, Osaka City University Graduate School of Medicine, Osaka, Japan; 4The Japan Pancreas Transplant Registry, The Japanese Pancreas and Islet Transplantation Association, Osaka, Japan
Background: The impact of pancreas transplantation (PTx) including kidney transplantation on patient survival is unknown. An analysis of the data of the Japan Pancreas Transplant Registry was performed to compare the patient survival between on the waiting list and after PTx and investigate the factors that affect the patient survival after pancreatic transplantation.
Methods: To evaluate the impact of PTx on patient survival, the patient survival on the waiting list (n = 699) and PTx recipients (n = 361) were compared using Simon and Makuch’s modified Kaplan-Meier curve and Cox proportional hazards regression analyses. The cases of PTx included 361 cases from brain-dead donors and 3 cases of donation after circulatory death, performed from 2000 to 2018 underwent at 18 centers in Japan.
Results: The cumulative survival rates of the patients on the waiting list at 1, 5, and 10 years was 98.4%, 90.3%, and 78.1%, respectively, while those of the PTx recipients was significantly improved (hazard ratio (HR):0.57, p = 0.029), at 100%, 97.5%, and 88.9%. The performance of PTx apparently improved patient survival on the waiting list. Next, the survival of patients who underwent each surgical procedure was compared. Among the patients waiting for SPK, the survival rates at 1, 5, and 10 years were 98.2%, 89.4%, and 75.4%, respectively, while those after SPK were significantly improved (HR:0.50, p = 0.026), at 100%, 94.6%, and 88.8%. Although SPK significantly improved the survival rate of type 1 diabetes patients with end-stage renal failure, PAK and PTA did not have a significant impact on the survival rate of the patients on the waiting list. Among patients waiting for PAK, the survival rates at 1, 5, and 10 years were 100%, 96.9%, and 89.8%, respectively, while the survival rates after PAK tended to be better at 100%, 100%, and 94.1%. However, the difference was not statistically significant. However, in the case of PTA, the patient survival was not improved (HR:1.95, p = 0.49). Among patients on the waiting list, the survival rates of 1, 5, and 10 years were 96.3%, 84.3%, and 84.3%, respectively, while those of the transplantation recipients were 100%, 88.9%, and 61.0%.
In the cases of SPK, when the patients were compared according to the median duration of diabetes before surgery (28 years), a <28-year history of diabetes did not significantly increase the HR. However, a significant increase was observed in patients with a >35-year history of diabetes (HR:1.945, 95% Confidence interval (CI) = 1.264–2.992), and those with a >40-year history of diabetes (HR:4.056, 95% CI = 1.727–9.527).
Conclusion: PTx was found to improve the life prognosis of type 1 diabetic patients, especially those with end-stage renal failure who were waiting for SPK. The present study also revealed that among patients waiting for SPK, the survival rate decreased according to the duration of diabetes before surgery. Thus, it is desirable to perform transplantation as early as possible.
We thanks Masaaki Watanabe and Yasuyuki Koshiduka (Hokkaido University Hospital), Shigehito Miyagi and Kazuaki Tokodai (Tohoku University Hospital), Takuro Saito and Akira Kenjo (Fukushima Medical University Hospital), Keiichi Kubota and Masato Kato (Dokkyo Medical University Hospital), Ichiro Nakajima and Ichiro Koyama (Tokyo Women’s Medical University Hospital), Shigeyuki Kawachi and Hitoshi Iwamot (Tokyo Medical University Hachioji Medical Center), Michihiro Maruyama and Kazunori Otsuki (National Chiba-Higashi Hospital), Toshifumi Wakai and Takashi Kobayashi (Niigata University Hospital), Shunji Narumi and Takahisa Hiramitsu (Nagoya Daini-Red Cross Hospital), Hidetaka Ushigome and Shuji Nobori (Kyoto Prefectural University Hospital), Hideaki Okajima and Takayuki Anazawa (Kyoto University Hospital), Hidetoshi Eguchi and Yoshito Tomimaru (Osaka University Hospital), Hirochika Toyama and Sachio Terai (Kobe University Hospital), Hideki Ohdan and Hiroyuki Tahara (Hiroshma University Hospital), Keiichi Okano and Minoru Oshima (Kagawa University Hospital), Shinichiro Ono and Tomohiko Adachi (Nagasaki University Hospital) and Keizo Kaku and Yasuhiro Okabe (Kyushu University Hospital) for their cooperation with the registry of Japanese Pancreas Transplantation..