• Braulio A Marfil-Garza, Joshua Hefler, Kevin Verhoeff, Anna Lam, Khaled Dajani, Blaire Anderson, Doug O'Gorman, Tatsuya Kin, Omar Yaxmehen Bello-Chavolla, Donald Grynoch, Anne Halpin, Patricia M Campbell, Peter A Senior, David Bigam, and ShapiroA M JamesAMJDepartment of Surgery.Clinical Islet Transplant Program.Alberta Diabetes Institute, Edmonton, Canada..
• Department of Surgery.
• Ann. Surg. 2023 Apr 1; 277 (4): 672680672-680.

ObjectiveTo provide the largest single-center analysis of islet (ITx) and pancreas (PTx) transplantation.Summary Background DataStudies describing long-term outcomes with ITx and PTx are scarce.MethodsWe 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.ResultsCrude 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).ConclusionsPTx 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.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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