Over 1000 Pancreas Transplants in a Latin American Program

Pancreas transplantation (PT) is an effective treatment for patients with type 1 diabetes and end-stage renal disease, or brittle diabetes. However, the total number of PT and high-volume programs has declined worldwide during the past decade. This study aimed to analyze the experience of >1000 PTs in a high-volume Brazilian program.

We analyzed 1073 PTs performed from 1996 to 2021, with 593 simultaneous pancreas-kidney (SPK) transplants and 480 solitary PTs, of which 331 were pancreas after kidney (PAK) transplants and 149 PT alone (PTA). Among the 480 solitary PTs, there were 379 primary PAK/PTA and 101 solitary pancreas retransplants (PRTs). Transplants were divided into 3 eras, according to the predominant surgical technique used during each period. The immunosuppression protocol was based on thymoglobulin, tacrolimus, mycophenolate mofetil/sodium, and steroids. Surgical techniques have progressed from systemic-bladder to portal-enteric, portal-duodenal, and presently, systemic-enteric, either to the native duodenum or via duodenojejunostomy.

The overall 1-y patient survival was >90% for primary PTA/PAK and 85% for SPK or PRT. One-year death-censored graft survival was superior for SPK-kidney and SPK-pancreas (97% and 90%, respectively) and 75% for all subgroups of solitary PTs (PAK, PTA, and PRT). There was a significant reduction in cold ischemia time and a decreased rate of pancreatic thrombosis over time, as low as 2%, in SPK recipients.

During the course of 25 y, our PT program has consistently maintained a high-volume activity and has recently emerged as one of the world's most active programs, conducting >60 PT procedures annually.