Clin Transplant Res.  2024 Sep;38(3):203-211. 10.4285/ctr.24.0033.

Experience from 100 consecutive pancreas transplants amidst low national transplant activity: a retrospective study at a single center in Korea

• Ryu JH
• Yang KH
• Horneland R
• Ju SH
• Choi BH

• KMID: 2559808
• DOI: http://doi.org/10.4285/ctr.24.0033

Abstract

Background
Since 1992, over 800 pancreas transplants have been performed in Korea. However, this number is significantly lower compared to the number of kidney or liver transplants.
Methods
Between 2015 and July 2023, Pusan National University Yangsan Hospital conducted 100 pancreas transplants, accounting for about 20% of all transplants performed in Korea during this period. The study comprised 27 simultaneous pancreas and kidney (SPK) transplants, 23 pancreas after kidney (PAK) transplants, and 50 pancreas transplant alone (PTA) cases. Duodenoduodenostomy was the primary surgical technique employed for exocrine drainage, along with various modifications of the venous outflow anastomosis.
Results
The availability of brain-dead donors for kidney transplants was lower compared to isolated pancreas transplants. Patients undergoing SPK transplants faced significantly longer waiting times than those receiving PTA or PAK transplants. The rate of surgical complications was acceptable, with a notably low thrombotic graft failure rate of 1.0%. In the PTA group, acute rejection of the graft pancreas occurred frequently (18.0%), though this was not statistically significant (P=0.328). The pancreas transplantation survival rates were 91.0%, 78.5%, and 75.4% at 1, 5, and 9 years, respectively. The PTA group exhibited a lower graft survival rate than the SPK and PAK groups, with marginal statistical significance (P=0.059).
Conclusions
Graft survival rates have improved over time due to advancements in surgical techniques and immunosuppressant strategies. By sharing our experiences, we aim to enhance the activity and success of pancreas transplantation in Korea.

Keyword

Pancreas transplant; Simultaneous pancreas and kidney transplant; Pancreas after kidney Transplant; Pancreas transplant alone

Figure

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  Fig. 1 The number of pancreas transplants performed in Korea between 2015 and July 2023. During the period, a total of 442 pancreas transplants were performed, of which 102 transplants were conducted at the Pusan National University Yangsan Hospital (PNUYH), Korea.

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  Fig. 2 (A) Illustration of a duodenoduodenostomy performed for enteric drainage and an aortic interposition graft to the inferior vena cava for venous outflow. A kidney transplant was performed on the patient’s left side. (B) Duodenojejunostomy with ipsilateral kidney transplant. This is the latest version of our procedure. The kidney can be positioned on the left side if the right common iliac artery of the recipient has extensive calcification. D, duodenum; C, vena cava; A, aorta; AG, aortic graft. Illustrations created by Rune Horneland.

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  Fig. 3 Kaplan-Meier survival curves. (A) The graft survival rates of pancreas transplants performed at Pusan National University Yangsan Hospital. The 1-, 5-, and 9-year graft survival rates were 91.0%, 78.5%, and 75.4%, respectively. Graft survival was defined as insulin independence. (B) The graft survival rates of SPK, PAK, and PTA. The 1-, 5-, and 9-year graft survival rates were 92.3%, 87.9%, and 87.9% for SPK, 87.0%, 87.0%, and 87.0% for PAK, and 91.7%, 69.2, and 64.6% for PTA, respectively. (C) The graft survival rate between SPK/PAK versus PTA. With borderline statistical significance (P=0.059, log-rank test), PTA had a lower graft survival rate. SPK, simultaneous pancreas and kidney; PAK, pancreas after kidney; PTA, pancreas transplant alone.

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