Survival Worse After Pancreas Transplant

By Jennifer Warner People with severe type 1 diabetes may be better off on the pancreas transplant waiting list than actually getting the organ. A new study shows that people with diabetes and normal kidney function who had a whole-organ pancreas transplant were more likely to die within the first four years after getting the transplant than those under conventional care on the transplant waiting list.

People with severe type 1 diabetes may be better off on the pancreas transplant waiting list than actually getting the organ.A new study shows that people with diabetes and normal kidney function who had a whole-organ pancreas transplant were more likely to die within the first four years after getting the transplant than those under conventional care on the transplant waiting list.Researchers say whole-organ pancreas transplants are a treatment option for some people with advanced forms of type 1 diabetes in order to achieve normal sugar levels and reduce or eliminate their dependence on insulin shots. In people with type 1 diabetes, the pancreas is no longer able to produce enough insulin to meet the body’s needs in order to regulate blood sugar levels.The American Diabetes Association recommends pancreas transplants only for people with type 1 diabetes who have had or need a kidney transplant or those patients with frequent episodes of extremely low blood sugars or extremely high blood sugar levels with a buildup of blood acids (known as ketoacidosis).But researchers say pancreas transplantation alone remains a controversial option because of the high rate of complications, risk of death, and expense of the procedure and a lack of proven benefits in easing or reversing some of the health risks associated with diabetes. Study Questions Value of Pancreas TransplantsIn the study, researchers compared data obtained from 124 transplant centers in the U.S. on 11,572 people with type 1 diabetes who were on the transplant waiting list for a whole-organ pancreas.After four years of follow up, researchers found that patients who had type 1 diabetes and solid kidney function, who received a pancreas transplant alone had a 57% higher risk of death compared with those on the waiting list receiving conventional therapy to treat their diabetes. For example, survival rates for pancreas transplant alone recipients were 97% one year after the procedure and 85% after four years compared with survival rates of 98% and 92% among those on the pancreas alone transplant waiting list. “Our data suggest that patients with complicated diabetes who are considering a solitary pancreas transplant must weigh the potential benefit of insulin independence against an apparent increase in mortality for at least the first four years posttransplantation,” write research Jeffrey M. Venstrom, BS, of the National Institute of Diabetes and Digestive Kidney Diseases, and colleagues.”Benefits not accounted for in this analysis (e.g., improved quality of life) may justify pancreas transplantation, and it is possible that transplant recipients may show a survival advantage with longer-term follow-up,” they write.But even if that is true, researchers say it’s hard to weigh the cost of an increased risk of death within the first four years after transplantation against a hypothetical survival advantage beyond those four years.Second Thoughts on Pancreas TransplantationIn an editorial that accompanies the study, David M. Nathan, MD, of Harvard Medical School, says the study should temper enthusiasm for pancreas transplant alone. “There may be some patients in whom quality of life is so severely compromised that the potential benefits of pancreas transplant and pancreas-after-kidney transplantation outweigh the risks,” writes Nathan. “However, such patients must be selected very carefully and be fully informed of the results of the current study.”Nathan notes that at least part of the reason why pancreas transplant recipients didn’t fare as well as those on being treated on the waiting list is that improvements in the treatment of diabetes have improved the long-term outlook for all people with diabetes.”The dilemma with isolated pancreas transplantation will be to resist new and attractive procedures that carry increased risk when safer, conventional therapy is available,” writes Nathan.(source Webmd.com)