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Recipient selection and evaluation for vascularized pancreas transplantation
R J Stratta1, R J Taylor, T O Wahl
1Department of Surgery, University of Nebraska Medical Center, Bishop Clarkson Memorial Hospital, Omaha 68198.
Transplantation
|May 1, 1993
Summary
Pancreas transplantation (PT) selection criteria were refined using renal dysfunction and cardiovascular risk assessments. This multidisciplinary approach optimized patient selection, with nearly 75% of evaluated diabetic patients accepted for PT, improving outcomes.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Immunology
Background:
- Vascularized pancreas transplantation (PT) is an established therapy for select type 1 diabetic patients.
- Patient selection and evaluation criteria for PT require further clarification.
- Optimizing allograft resource utilization necessitates precise candidate selection.
Purpose of the Study:
- To define and evaluate recipient selection criteria for pancreas transplantation.
- To assess the outcomes of pancreas transplantation based on established criteria.
- To determine the proportion of diabetic patients suitable for pancreas transplantation.
Main Methods:
- Evaluated 151 diabetic patients for PT over 3.5 years, interviewing 205.
- Utilized renal dysfunction (creatinine clearance) to stratify patients for combined pancreas-kidney (PKT) or solitary pancreas transplantation (PTA).
- Employed cardiovascular evaluation, including stress thallium studies and coronary angiography, to assess operative risk.
Main Results:
- 104 patients were selected for PT; 70 underwent PKT with high patient (98.6%) and graft survival rates (kidney 97.1%, pancreas 94.2%).
- PTA candidates required ≥2 diabetic complications or hyperlabile diabetes, with 12 patients achieving 83.3% patient and 50% pancreas graft survival.
- 33 patients (24.1%) were not selected; 9 died before or during transplantation.
Conclusions:
- A multidisciplinary approach incorporating nephropathy, cardiovascular risk, and diabetic complications is effective for PT recipient selection.
- Nearly 75% of evaluated diabetic patients were suitable candidates for PT.
- Appropriate patient selection minimizes mortality while awaiting or undergoing PT, optimizing scarce allograft resources.