Quality of life after pancreas transplantation: a review

For persons with diabetes and end stage renal disease, successful combined or sequential pancreas/kidney transplant is an attractive therapeutic alternative to insulin and dialysis. There is considerable controversy regarding pancreas transplantation (p Tx), however, as some recent reviews have concluded, p Tx results in at most only modest reductions in secondary complications and has increased morbidity and costs compared with kidney transplant alone. While the impact on patients' quality of life (QOL) is a major consideration for p Tx, the literature on this topic has not been carefully considered. The purpose of this review is to evaluate studies of QOL after p Tx and identify well-validated findings. Comparative cross-sectional and longitudinal studies have shown that the QOL outcomes of p Tx recipients who achieve insulin-independence are better than those of candidates or of recipients with pancreas graft loss. More positive health perceptions, improved social interaction and increased vitality/energy are significantly associated with successful p Tx. Researchers have found few areas where the QOL benefits of p Tx significantly exceed or differ from those that occur with kidney transplant alone. A consistent finding across studies is that p Tx improves patient perceptions about diabetes-specific issues such as satisfaction with diet flexibility and health management, while kidney transplant does not. Future studies should attempt to accrue sufficient sample sizes to permit statistical adjustment for selection biases; follow patients for several years to permit differences in rates of progression of secondary complications to impact QOL; and use current graft loss and morbidity statistics to estimate any added risks of p Tx over kidney-only transplant. It is still an open question as to whether or not there are sufficient QOL benefits from p Tx long-term to out-weigh added risks, and this needs to remain an active area of investigation.