Health
Pancreas Transplant in Diabetics Can Be Risky
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Pancreas Transplant in Diabetics Can Be Risky
Friday December 5, 2003
Pancreas Transplant in Diabetics Can Be Risky
By Anthony J. Brown, MD
NEW YORK (Reuters Health) - Diabetics who receive a pancreas transplant are about 50 percent more likely to die in the next few years than their peers who are awaiting transplantation and receive standard therapy, new research indicates. In contrast, simultaneous pancreas-kidney transplantation may lower the risk of death.
People with type 1 diabetes have high sugar levels in their blood because the pancreas doesn't produce enough insulin--the hormone that lowers blood sugar levels. Pancreas transplantation can potentially restore production of the hormone so that patients do not require daily insulin injections.
These findings are meant to inform diabetics and doctors of the risks of pancreas transplantation, senior author Dr. David M. Harlan, from the National Institutes of Health in Bethesda, Maryland, told Reuters Health. For some patients, "the increased mortality risk may be a fair trade-off for the possibility of not requiring insulin," he added.
In the study, published in the Journal of the American Medical Association, Harlan's team assessed the outcomes of 11,572 diabetic patients who were on the waiting list for pancreas transplantation between 1995 and 2000. During this period, about half of the patients underwent transplantation, usually simultaneous pancreas-kidney transplantation.
Receiving just a pancreas or a kidney and then a pancreas was associated with an increased risk of death in the four years after surgery. In contrast, receiving a pancreas and a kidney at the same time was associated with a decreased risk of death.
The four-year survival rate for diabetics who received only a pancreas was 85 percent, while the rate for their peers still on the waiting list was 92 percent. In regards to pancreas-after-kidney transplantation, the corresponding rates were 85 and 88 percent.
So why does pancreas transplantation alone seem harmful and simultaneous pancreas-kidney transplantation appear beneficial?
"One possibility is that solitary pancreas transplantation is, for some unknown reason, a more complicated procedure with higher operative" death risk, Harlan commented. "However, we looked at that and postsurgical survival following both procedures was almost identical."
The answer seems to involve the prognosis of each comparison group--the patients who were awaiting transplantation.
"If you have diabetes and kidney failure, you're prognosis is dismal" and, therefore, there is less to lose and much to gain from transplantation, Harlan explained. "In contrast, patients with poorly controlled diabetes, but without kidney failure have a surprisingly good prognosis" with standard therapy, so transplantation is a much riskier endeavor, he added.
The results suggest that "the enthusiasm for simultaneous pancreas-kidney transplantation is probably justified," Dr. David M. Nathan, from Harvard Medical School in Boston, notes in a related editorial.
"The more sobering finding is that for pancreas-after-kidney transplantation and pancreas transplant alone, the relative increase in mortality in the three-month period after the transplant was not balanced by an improvement in survival over the next four years," he adds.
SOURCE: Journal of the American Medical Association, December 3, 2003.
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