Pancreas and Islet Transplantation: Comparative Outcome Analysis of a Single-centre Cohort Over 20-years.
Journal
Annals of surgery
ISSN: 1528-1140
Titre abrégé: Ann Surg
Pays: United States
ID NLM: 0372354
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
pubmed:
21
12
2022
medline:
14
3
2023
entrez:
20
12
2022
Statut:
ppublish
Résumé
To provide the largest single-center analysis of islet (ITx) and pancreas (PTx) transplantation. Studies describing long-term outcomes with ITx and PTx are scarce. We included adults undergoing ITx (n=266) and PTx (n=146) at the University of Alberta from January 1999 to October 2019. Outcomes include patient and graft survival, insulin independence, glycemic control, procedure-related complications, and hospital readmissions. Data are presented as medians (interquartile ranges, IQR) and absolute numbers (percentages, %) and compared using Mann-Whitney and χ2 tests. Kaplan-Meier estimates, Cox proportional hazard models and mixed main effects models were implemented. Crude mortality was 9.4% and 14.4% after ITx and PTx, respectively ( P= 0.141). Sex-adjusted and age-adjusted hazard-ratio for mortality was 2.08 (95% CI, 1.04-4.17, P= 0.038) for PTx versus ITx. Insulin independence occurred in 78.6% and 92.5% in ITx and PTx recipients, respectively ( P= 0.0003), while the total duration of insulin independence was 2.1 (IQR 0.8-4.6) and 6.7 (IQR 2.9-12.4) year for ITx and PTx, respectively ( P= 2.2×10 -22 ). Graft failure ensued in 34.2% and 19.9% after ITx and PTx, respectively ( P =0.002). Glycemic control improved for up to 20-years post-transplant, particularly for PTx recipients (group, P= 7.4×10 -7 , time, P =4.8×10 -6 , group*time, P= 1.2×10 -7 ). Procedure-related complications and hospital readmissions were higher after PTx ( P =2.5×10 -32 and P= 6.4×10 -112 , respectively). PTx shows higher sex-adjusted and age-adjusted mortality, procedure-related complications and readmissions compared with ITx. Conversely, insulin independence, graft survival and glycemic control are better with PTx. This study provides data to balance risks and benefits with ITx and PTx, which could improve shared decision-making.
Sections du résumé
OBJECTIVE
To provide the largest single-center analysis of islet (ITx) and pancreas (PTx) transplantation.
SUMMARY BACKGROUND DATA
Studies describing long-term outcomes with ITx and PTx are scarce.
METHODS
We included adults undergoing ITx (n=266) and PTx (n=146) at the University of Alberta from January 1999 to October 2019. Outcomes include patient and graft survival, insulin independence, glycemic control, procedure-related complications, and hospital readmissions. Data are presented as medians (interquartile ranges, IQR) and absolute numbers (percentages, %) and compared using Mann-Whitney and χ2 tests. Kaplan-Meier estimates, Cox proportional hazard models and mixed main effects models were implemented.
RESULTS
Crude mortality was 9.4% and 14.4% after ITx and PTx, respectively ( P= 0.141). Sex-adjusted and age-adjusted hazard-ratio for mortality was 2.08 (95% CI, 1.04-4.17, P= 0.038) for PTx versus ITx. Insulin independence occurred in 78.6% and 92.5% in ITx and PTx recipients, respectively ( P= 0.0003), while the total duration of insulin independence was 2.1 (IQR 0.8-4.6) and 6.7 (IQR 2.9-12.4) year for ITx and PTx, respectively ( P= 2.2×10 -22 ). Graft failure ensued in 34.2% and 19.9% after ITx and PTx, respectively ( P =0.002). Glycemic control improved for up to 20-years post-transplant, particularly for PTx recipients (group, P= 7.4×10 -7 , time, P =4.8×10 -6 , group*time, P= 1.2×10 -7 ). Procedure-related complications and hospital readmissions were higher after PTx ( P =2.5×10 -32 and P= 6.4×10 -112 , respectively).
CONCLUSIONS
PTx shows higher sex-adjusted and age-adjusted mortality, procedure-related complications and readmissions compared with ITx. Conversely, insulin independence, graft survival and glycemic control are better with PTx. This study provides data to balance risks and benefits with ITx and PTx, which could improve shared decision-making.
Identifiants
pubmed: 36538619
doi: 10.1097/SLA.0000000000005783
pii: 00000658-202304000-00019
doi:
Substances chimiques
Insulin
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
672-680Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
B.A.M.-G. is a co-inventor for a patent on TNFRSF25-mediated treatments of immune diseases and disorders (PCT/US2020/053085). P.A.S. serves in an independent data monitoring committee overseeing safety of stem cell-derived β-cells for T1D (Vertex Pharmaceuticals), as Board Chair for Diabetes Canada, and as a co-lead for Diabetes Action Canada’s innovations in T1D goal group. A.M.J.S. has received grants or contracts from the Juvenile Diabetes Research Foundation, Canadian Stem Cell Network, Diabetes Research Foundation in Canada, ViaCyte Inc., and the National Institutes of Diabetes and Digestive and Kidney Diseases. A.M.J.S. serves as a consultant to Protokinetix Inc., ViaCyte Inc., Hemostemix Inc., Diagon Inc., and Aspect Biosystems Inc. A.M.J.S. is a co-inventor for a patent on TNFRSF25-mediated treatments of immune diseases and disorders (PCT/US2020/053085) and for a Cellular Transplant Site- Device-less technology (US 14/863541, CA.286512). The remaining authors report no conflicts of interest.
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