An analysis of the association between older recipient age and outcomes after whole organ pancreas transplantation.
Mittal S., Smilevska R., Franklin R., Hammer C., Knight S., Vrakas G., Reddy S., Gilbert J., Quiroga I., Sharples E., Ploeg R., Friend P., Sinha S.
Older people are being increasingly referred for considerations for pancreas transplantation (PT). We investigated the outcomes after PT in our older recipient cohort to establish if offering transplantation to this cohort is justified. A prospectively-maintained database was interrogated. The cohort was analysed for associations between outcome and older recipient age. 444 transplants were performed in patients aged 23-54 years and 83 transplants in patients aged 55- 67 years. There was no difference in death-censored pancreas or kidney graft survival between the groups. Patient death was associated with older recipient age (HR 1.63 per ten-year increase). In multivariate Cox regression, risk of mortality was also associated with post-transplant myocardial infarction (HR 7.25, p=0.006), pancreas failure (HR 1.91, p=0.003) and kidney failure (HR 3.55, p<0.001). 40% of recipients that died in the first year post-transplant suffered early graft loss. Those alive at a year post-transplant had inferior survival if they had lost their kidney graft. (p<0.001). Mortality is higher in older patients, and is strongly associated with pancreas and kidney graft failure. This suggests that pancreas transplantation is feasible in older recipients, but careful selection of donor organs is important to optimise survival.