Pancreas and Islet Transplantation : Comparative Outcome Analysis of a Single-centre Cohort Over 20-years
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved..
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.
| Errataetall: |
ErratumIn: Ann Surg. 2023 Aug 1;278(2):e429. - PMID 37272357 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:277 |
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| Enthalten in: |
Annals of surgery - 277(2023), 4 vom: 01. Apr., Seite 672-680 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Marfil-Garza, Braulio A [VerfasserIn] |
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| Anmerkungen: |
Date Completed 13.03.2023 Date Revised 17.07.2023 published: Print-Electronic ErratumIn: Ann Surg. 2023 Aug 1;278(2):e429. - PMID 37272357 Citation Status MEDLINE |
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| doi: |
10.1097/SLA.0000000000005783 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM350502870 |
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| 100 | 1 | |a Marfil-Garza, Braulio A |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pancreas and Islet Transplantation |b Comparative Outcome Analysis of a Single-centre Cohort Over 20-years |
| 264 | 1 | |c 2023 | |
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| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 13.03.2023 | ||
| 500 | |a Date Revised 17.07.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ErratumIn: Ann Surg. 2023 Aug 1;278(2):e429. - PMID 37272357 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a OBJECTIVE: To provide the largest single-center analysis of islet (ITx) and pancreas (PTx) transplantation | ||
| 520 | |a SUMMARY BACKGROUND DATA: Studies describing long-term outcomes with ITx and PTx are scarce | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 7 | |a Insulin |2 NLM | |
| 700 | 1 | |a Hefler, Joshua |e verfasserin |4 aut | |
| 700 | 1 | |a Verhoeff, Kevin |e verfasserin |4 aut | |
| 700 | 1 | |a Lam, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Dajani, Khaled |e verfasserin |4 aut | |
| 700 | 1 | |a Anderson, Blaire |e verfasserin |4 aut | |
| 700 | 1 | |a O'Gorman, Doug |e verfasserin |4 aut | |
| 700 | 1 | |a Kin, Tatsuya |e verfasserin |4 aut | |
| 700 | 1 | |a Bello-Chavolla, Omar Yaxmehen |e verfasserin |4 aut | |
| 700 | 1 | |a Grynoch, Donald |e verfasserin |4 aut | |
| 700 | 1 | |a Halpin, Anne |e verfasserin |4 aut | |
| 700 | 1 | |a Campbell, Patricia M |e verfasserin |4 aut | |
| 700 | 1 | |a Senior, Peter A |e verfasserin |4 aut | |
| 700 | 1 | |a Bigam, David |e verfasserin |4 aut | |
| 700 | 1 | |a Shapiro, A M James |e verfasserin |4 aut | |
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