1 pancreas

Waiting list ...................... Deceased donation ......... Transplant ....................... Donor-recipient matching Outcomes ........................ Transplant center maps...

4 9 10 12 13 17

R. Kandaswamy1,2 , M. A. Skeans1 , S. K. Gustafson1 , R. J. Carrico 3,4 , K. H. Tyler3,4 , A. K. Israni1,5,6 , J. J. Snyder1,5 , B. L. Kasiske1,6

1

Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN

2

Department of Surgery, University of Minnesota, Minneapolis, MN

3

Organ Procurement and Transplantation Network, Richmond, VA

4

United Network for Organ Sharing, Richmond, VA

5

Department of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN

6

Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN

pancreas OPTN/SRTR 2013 Annual Data Report:

ABSTRACT Pancreas listings and transplants decreased during the past decade, most notably pancreas after kidney transplants. Center-reported outcomes of pancreas transplant across all groups, short-term and long-term, improved during the same period. Changes to the pancreas allocation system creating an efficient, uniform national system will be implemented in late 2014. Pancreas-alone and simultaneous pancreas-kidney (SPK) candidates will form a single match-run list with priority to most SPK candidates ahead of kidney-alone candidates to decrease waiting times for SPK candidates, given their higher waitlist mortality compared with nondiabetic kidney transplant candidates. The changes are expected to eliminate local variability, providing more consistent pancreas allocation nationwide. Outcomes after pancreas transplant are challenging to interpret due to lack of a uniform definition of graft failure. Consequently, SRTR has not published data on pancreas graft failure for the past 2 years. The Organ Procurement and Transplantation Network Pancreas Transplantation Committee is working on a definition that could provide greater validity for future outcomes analyses. Challenges in pancreas transplantation include high risk of technical failures, rejection (early and late), and surgical complications. Continued outcome improvement and innovation has never been more critical, as alternatives such as islet transplant and artificial pancreas move closer to clinical application.

KEY WORDS Pancreas after kidney transplant, pancreas allocation policy, pancreas transplant alone, simultaneous pancreas-kidney transplant.

One of the hardest and best decisions I�ve ever made was to donate my son�s organs. We are two families brought together by one awesome young man who wanted to do something great and leave his mark on this world. He did exactly that. Andi, donor mother

2

OPTN/SRTR 2013 Annual Data Report

Introduction Several major initiatives are underway in the field of pancreas transplantation. One is the implementation of substantial changes to the national pancreas allocation system. When the changes are implemented, simultaneous pancreas-kidney (SPK) and pancreas transplant alone (PTA) candidates will combine to form a single match-run list. SPK candidates will no longer have to compete against non-diabetic kidney transplant candidates. PTA candidates will be on equal footing with SPK candidates, rather than prioritized at the discretion of their organ procurement organizations. Access to both types of pancreas transplant is expected to improve. Another initiative is the Organ Procurement and Transplantation Network Pancreas Transplantation Committee's project to define pancreas allograft failure. Because the indications for pancreas transplant are multiple type 1, type 2, or marginal diabetes with or without kidney failure creating a single definition of success or failure is a challenge. In addition, belief in the necessity of insulin independence posttransplant varies among transplant centers and physicians. Thus, set criteria for pancreas graft failure that apply to all disease groups are challenging to formulate. Multiple measurements will be needed at transplant and follow-up to assess glycemic control, quantify insulin use, indicate islet function, and identify insulin resistance in pancreas recipients. An initial definition using existing data, with opportunity for refinement as more data fields are added, is one strategy being considered. A detailed analysis of pancreas transplant trends over the past decade is presented in the following sections.

Waiting List Numbers of new candidates on the pancreas waiting list steadily decreased from 2477 in 2002 to 1615 in 2013. A slight increase in the number of PTA candidates occurred in 2013, when 247 were listed, compared with 218 the previous year (Figure PA 1.1). Numbers of prevalent candidates (inactive and active) steadily decreased, from 3499 in 2002 to 2937 in 2013. Numbers of active candidates also decreased, from 2776 in 2002 to 1186 in 2013 (Figure PA 1.1). Proportions of older candidates (aged ě 50 years) gradually increased in the past decade, to 25.7% in 2013, with a corresponding decrease in the proportions of younger candidates (aged 18-34 years), to 20.6% in 2013 (Figure PA 1.2). Proportions of white candidates decreased over the past decade, to 65.6% in 2013, with corresponding increases in the proportions of black (19.7% in 2013) and Hispanic (11.4% in 2013) candidates. The proportion of candidates reported to have type 2 diabetes was 8.9% in 2013, increased from a nadir of 7.3% in 2007. The proportion of obese candidates (body

mass index ě 30 kg/m2 ) increased to 19.1% in 2013, compared with 12.6% in 2002, in keeping with national trends in the general population. Of pancreas waitlist candidates, 14.1% were waiting for PTA, 16.2% for pancreas after kidney (PAK) transplant, and 69.7% for SPK, almost unchanged from the previous year. A comparison of the characteristics of adults on the pancreas transplant waiting list on December 31 of 2003 and 2013 is shown in Figure PA 1.3. Of note, retransplant SPK and PAK listings increased from 14.7% and 5.5% in 2003 to 22.3% and 31.5% in 2013. Also, percentages of unsensitized candidates (panel-reactive antibody [PRA] < 1%) decreased from 63.4%, 52.0%, and 60.0% to 57.0%, 47.7%, and 42.2% for PTA, SPK, and PAK, respectively. Transplant rates increased for all groups over the past decade, and were 87.7, 76.7, and 78.5 per 100 active waitlist years for PTA, SPK, and PAK, respectively, in 2013 (Figure PA 1.4). Transplant rates by donation service area (DSA) (Figure PA 1.5) showed substantial geographic disparity, and some DSAs performed very few transplants. This disparity may be partially mitigated, at least for SPK transplants, by the changes to the pancreas allocation system. Looking at the percentages of candidates who underwent transplant within 2 years, it is remarkable that in at least five DSAs, at least 75% of candidates listed for SPK underwent transplant within 2 years, while in eight DSAs, 25% or less did so (Figure PA 1.6). The median numbers of months to pancreas transplant in 2012-2013 were 16.5, 18.6, and 19.3 for PTA, SPK, and PAK, respectively, compared with 19.5, 22.2, and 38.8, respectively, in 2010-2011 (Figure PA 1.9). Pancreas waitlist mortality rates remained steady over the past 2 years except for the PTA rate, which increased from 2.3 per 100 waitlist years in 2012 to 5.2 in 2013. Whether this is an aberration or a trend remains to be seen. The pancreas waitlist mortality rate also increased sharply for older candidates (aged ě 50 years), from 5.3 in 2012 to 8.5 in 2013 (Figure PA 1.10). More than 95% of candidates listed for SPK or PTA are exclusive to that list. Dual listing or moving from one list to the other usually denotes the occurrence of a living donor kidney transplant in an SPK candidate, or deterioration of kidney function in a PTA candidate who now needs a kidney transplant (Figure PA 1.11).

Donation Deceased donor pancreas donation rates have gradually decreased since 2005. Only pancreata recovered for the purpose of pancreas transplant (not islet transplant) were included in the analysis. The overall rate was lowest in 2011, at 2.2 donors aged younger than 75 years per 1000 deaths (Figure PA 2.1). The

3 pancreas

rate for donors aged 15 to 34 years decreased in 2011 to 14 per 1000 deaths, compared with slightly over 15 in 2010. Unadjusted geographic heterogeneity in donation rates is substantial (Figure PA 2.2). The rate of pancreata recovered for transplant and not transplanted correlates strongly with donor age. Overall, this rate has decreased over the past 3 years, from 27.7% in 2011 to 24.0% in 2013, but variation with age was substantial (Figure PA 2.3). Over the past decade, several donor-specific components of the pancreas donor risk index have changed notably. Percentages of donors aged older than 28 years or whose cause of death was cerebrovascular accident or stroke have decreased, and percentages of donors of black race have increased (Figure PA 2.4). The percentage of donation after circulatory death donors has hovered around 3% over the past few years (Figure PA 2.5). Head trauma was the most common cause of death, but anoxic brain injury has steadily increased and was the cause of death for 23.5% of donors in 2013 (Figure PA 2.6).

Transplant The number of pancreas transplants has steadily decreased since 2004, to 1018 in 2013 (Figure PA 3.1). However, 149 PTA transplants were performed in 2013, compared with 121 in 2012, the first increase in 5 years. In 2013, compared with the previous year, more transplants were performed in candidates in younger (aged 18-34 years) and older (aged ě 50 years) age groups, and fewer in candidates aged 35 to 49 years. Slightly more transplants were performed in candidates with type 2 diabetes in 2013 (Figure PA 3.2). More PTA recipients held private insurance (64.6%), compared with SPK recipients (40.4%). Of PAK transplants, 33.6% were retransplants, as were only 1.8% of SPKs (Figure PA 3.3). Immunosuppressive practice changed little in the past 5 years. T-cell depleting induction was used in 79.8% of all transplants in 2013. For maintenance, tacrolimus was used in 91.9% and mycophenolate in 89.6% of recipients. Steroids were used in 65.2% initially and in 75.0% of recipients at 1 year posttransplant (Figure PA 3.4).

Donor-Recipient Matching The percentage of unsensitized recipients (calculated PRA [CPRA] < 1%) has remained stable around 75% over the past 4 years (Figure PA 4.1). The distribution changed notably from 2009 to 2010 with the introduction of CPRA, when many more candidates were classified as unsensitized and fewer as slightly sensitized (CPRA 1-< 20%). Numbers of HLA mismatches were generally high across

all groups; 74.4% of PTA, 84.0% of SPK, and 76.2% of PAK recipients from 2009 through 2013 had more than three HLA mismatches. SPK recipients tended to have more mismatches than PAK or PTA recipients (Figure PA 4.2). The combination of a donor who was positive for cytomegalovirus and a recipient who was negative occurred for 27.4% of recipients. The corresponding percentage for Epstein-Barr virus was 12.9% (Figure PA 4.3).

Outcomes All of the following pancreas graft survival analyses were based on center-reported graft failure data, which is not audited against any uniform definition. Therefore, rates of pancreas graft outcomes should be viewed with this limitation in mind. Graft failure rates within the first 3 months posttransplant (often described as technical losses) have decreased steadily over the past decade from 12.4% in 20022003 to 7.6% in 2012-2013 (Figure PA 5.1). Rates were lowest among SPK recipients (2.5% for kidney, 4.9% for pancreas), and comparable for PTA and PAK (10.4% and 9.9%, respectively). Unadjusted actual 1- and 5-year pancreas graft survival for the 2008 cohort was 74.3% and 50.6% for PTA, 85.8% and 74.3% for SPK, and 78.7% and 62.0% for PAK (Figure PA 5.6). The better long-term survival for SPK is partly due to decreased incidence of rejection, but the difficulty in diagnosing rejection in PTA and PAK may play a role. Detection of an early rejection episode in SPK is more likely because serum creatinine can be used as a surrogate marker. Long-term kidney graft survival for SPK recipients continues to improve (Figure PA 5.2). All-cause graft failure was 4.5% at 1 year for transplants in 2012, 19.6% at 5 years for transplants in 2008, and 40.4% at 10 years for transplants in 2003. For PAK recipients, pancreas graft failure decreased over time; 1-year all-cause failure was 13.7%, 5-year was 37.6%, and 10-year was 57.5% (Figure PA 5.3). Deceased donor allcause kidney graft failure from the time of pancreas transplant was 2.3% at 1 year, 22.2% at 5 years, and 52.1% at 10 years (Figure PA 5.4). For PAK transplants with living donor kidneys, all-cause kidney graft failure was less than 1% at 1 year, 18.2% at 5 years, and 44.5% at 10 years (Figure PA 5.5). Incidence of first acute rejection at 1 and 2 years was 22.1% and 27.8% for PTA, 16.0% and 20.4% for SPK, and 17.4% and 22.5% for PAK (Figure PA 5.8). Overall incidence of posttransplant lymphoproliferative disorder at 5 years was 2.6% for PTA, 1.0% for SPK, and 0.9% for PAK; as expected, incidence was higher among recipients negative for EpsteinBarr virus (6.4% for PTA and 3.6% for SPK) (Figure PA 5.9).

data behind the figures can be downloaded from our website, at srtr.transplant.hrsa.gov

OPTN/SRTR 2013 Annual Data Report

4000

New patients: active PTA SPK PAK All

3000 Patients

4000

2000

1000

0

0 03

05

07 Year

09

11

13

03

Patients listed on Dec 31: active

4000

PTA SPK PAK All

3000 Patients

PTA SPK PAK All

2000

1000

4000

New patients: total

3000 Patients

waiting list

05

07 Year

09

11

13

11

13

Patients listed on Dec 31: total

3000 Patients

4

2000 1000

2000 PTA SPK

1000

0

PAK All

0 03

05

07 Year

09

11

13

03

05

07 Year

09

PA 1.1 Adults waiting for pancreas transplant A new patient is one who first joined one of the three lists during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. Concurrently listed candidates who are active at any program are considered active; those who are inactive at all programs are considered inactive.

PA 1.2 Distribution of adults waiting for pancreas transplant Candidates waiting for transplant any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Active and inactive patients are included.

5 pancreas

waiting list PTA Age

Sex Race

Citizenship

Primary diagnosis

Pancreas tx history Blood type

PRA/CPRA

Waiting time

BMI (kg/m2 )

All candidates

18-34 35-49 50-64 65+ Female Male White Black Hispanic Asian Other/unknown US citizen Non-citizen resident Non-citizen non-resident Other/unknown Diabetes type 1 Diabetes type 2 Diabetes type unk. Other First transplant Retransplant A B AB O < 1% 1-< 20% 20-< 80% 80-< 98% 98-100% < 1 year 1-< 2 years 2-< 3 years 3-< 4 years 4-< 5 years 5+ years < 18.5 18.5-< 25 25-< 28 28-< 30 30-< 35 35+ Unknown

N 91 273 68 2 242 192 399 12 19 2 2 430 2 1 1 388 15 3 28 396 38 155 51 9 219 275 87 31 19 22 175 82 92 29 13 43 7 213 114 48 28 6 18 434

% 21.0 62.9 15.7 0.5 55.8 44.2 91.9 2.8 4.4 0.5 0.5 99.1 0.5 0.2 0.2 89.4 3.5 0.7 6.5 91.2 8.8 35.7 11.8 2.1 50.5 63.4 20.0 7.1 4.4 5.1 40.3 18.9 21.2 6.7 3.0 9.9 1.6 49.1 26.3 11.1 6.5 1.4 4.1 100.0

2003 SPK N % 484 20.9 1,396 60.3 429 18.5 6 0.3 1,063 45.9 1,252 54.1 1,635 70.6 428 18.5 206 8.9 29 1.3 17 0.7 2,291 99.0 16 0.7 8 0.3 0 0.0 1,918 82.9 248 10.7 4 0.2 145 6.3 2,187 94.5 128 5.5 717 31.0 324 14.0 50 2.2 1,224 52.9 1,390 60.0 431 18.6 239 10.3 145 6.3 110 4.8 1,110 47.9 564 24.4 299 12.9 182 7.9 71 3.1 89 3.8 58 2.5 1,065 46.0 559 24.1 197 8.5 253 10.9 95 4.1 88 3.8 2,315 100.0

PAK N 143 587 176 3 394 515 764 78 57 6 4 901 5 2 1 826 32 4 47 706 203 331 111 29 438 434 313 104 33 25 389 240 152 85 25 18 19 384 229 103 114 24 36 909

% 15.7 64.6 19.4 0.3 43.3 56.7 84.0 8.6 6.3 0.7 0.4 99.1 0.6 0.2 0.1 90.9 3.5 0.4 5.2 77.7 22.3 36.4 12.2 3.2 48.2 47.7 34.4 11.4 3.6 2.8 42.8 26.4 16.7 9.4 2.8 2.0 2.1 42.2 25.2 11.3 12.5 2.6 4.0 100.0

PTA N 94 216 105 8 231 192 338 34 43 4 4 412 2 1 8 346 18 4 55 361 62 148 46 7 222 220 38 80 35 50 156 85 52 42 21 67 16 154 96 57 73 22 5 423

% 22.2 51.1 24.8 1.9 54.6 45.4 79.9 8.0 10.2 0.9 0.9 97.4 0.5 0.2 1.9 81.8 4.3 0.9 13.0 85.3 14.7 35.0 10.9 1.7 52.5 52.0 9.0 18.9 8.3 11.8 36.9 20.1 12.3 9.9 5.0 15.8 3.8 36.4 22.7 13.5 17.3 5.2 1.2 100.0

2013 SPK N % 386 19.5 1,102 55.6 487 24.6 6 0.3 911 46.0 1,070 54.0 1,163 58.7 499 25.2 246 12.4 46 2.3 27 1.4 1,922 97.0 24 1.2 1 0.1 34 1.7 1,624 82.0 205 10.3 26 1.3 126 6.4 1,818 91.8 163 8.2 639 32.3 285 14.4 51 2.6 1,006 50.8 1,129 57.0 178 9.0 315 15.9 134 6.8 225 11.4 802 40.5 494 24.9 243 12.3 162 8.2 98 4.9 182 9.2 37 1.9 763 38.5 515 26.0 244 12.3 319 16.1 91 4.6 12 0.6 1,981 100.0

PAK N 49 296 186 2 239 294 396 70 58 8 1 524 2 1 6 470 39 16 8 365 168 221 62 16 234 225 63 131 63 51 131 92 73 55 45 137 8 209 143 73 80 13 7 533

% 9.2 55.5 34.9 0.4 44.8 55.2 74.3 13.1 10.9 1.5 0.2 98.3 0.4 0.2 1.1 88.2 7.3 3.0 1.5 68.5 31.5 41.5 11.6 3.0 43.9 42.2 11.8 24.6 11.8 9.6 24.6 17.3 13.7 10.3 8.4 25.7 1.5 39.2 26.8 13.7 15.0 2.4 1.3 100.0

PA 1.3 Characteristics of adults on the pancreas transplant waiting list on December 31, 2003, and December 31, 2013 Patients waiting for transplant on December 31, 2003, and December 31, 2013, regardless of first listing date; active/inactive status is on this date, and multiple listings are not counted.

data behind the figures can be downloaded from our website, at srtr.transplant.hrsa.gov

6

OPTN/SRTR 2013 Annual Data Report

waiting list Diagnosis group

120

DM Type 1 DM Type 2 Other/unknown

100

Transplants per 100 wait-list years

Transplants per 100 wait-list years

120

80 60

Transplant type PTA SPK PAK All

100 80 60 40

40 03

05

07 Year

09

11

13

03

05

07 Year

09

11

13

PA 1.4 Deceased donor pancreas transplant rates among active adult waitlist candidates Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active waiting in a given year.

SPK

PTA

14.1 No data

33.0

68.6

115.6

506.3 222.5

No data

PAK

30.4 43.3

67.6

93.2

221.0 144.1

9.6 No data

32.2

63.8

91.6

506.7 154.4

PA 1.5 Deceased donor pancreas transplant rates per 100 waitlist years among active adult candidates, by DSA, 2012-2013 Transplant rates by DSA of the listing center, limited to candidates with active time on the waiting list in 2012 and 2013; deceased donor transplants only. Maximum time per listing is 2 years. Candidates listed concurrently in a single DSA are counted separately.

SPK

PTA

14.0 No data

25.0

35.0

50.0

89.7 74.0

No data

PAK

20.8 30.5

78.2 43.0

54.5

67.4

21.6 No data

25.7

34.5

44.4

87.8 58.9

PA 1.6 Percentage of adult waitlisted candidates who underwent deceased donor pancreas transplant within 2 years, by DSA, 2011 Candidates listed concurrently in a single DSA are counted once in that DSA; candidates listed in multiple DSAs are counted separately per DSA.

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waiting list Patients at start of year Patients added during year Patients removed during year Patients at end of year Removal reason Deceased donor transplant Living donor kidney transplant Patient died Patient refused transplant Improved, tx not needed Too sick for transplant Changed to kidney-pancreas list Other

2011 510 218 264 464

PTA 2012 464 218 272 410

2013 410 247 234 423

2011 2,174 1,220 1,316 2,078

SPK 2012 2,077 1,307 1,304 2,080

2013 2,079 1,162 1,265 1,976

2011 680 228 273 635

PAK 2012 635 178 230 583

2013 583 170 220 533

142 0 18 23 10 19 8 44

121 0 10 20 8 11 9 93

139 0 22 13 6 14 8 32

834 106 134 10 13 87 0 132

840 89 150 12 6 73 0 134

801 88 142 10 9 69 0 146

115 0 19 25 4 36 8 66

89 0 13 25 5 31 13 54

92 0 16 16 7 21 9 59

PA 1.7 Pancreas transplant waitlist activity among adults Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.

Median months to transplant

100 PTA SPK PAK

80 60 40 20 0 02-03

04-05

06-07 08-09 Year of listing

10-11

12-13

PA 1.8 Three-year outcomes for adults waiting for pancreas transplant, new listings in 2010

PA 1.9 Median months to pancreas transplant for waitlisted adults

Adults waiting for any pancreas transplant and first listed in 2010. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor; LD, living donor.

Observations censored at earliest of December 31, 2013, transfer to another center, or removal from waiting list due to imporved condition; otherwise, candidates contribute waiting time until deceased donor transplant. Kaplan-Meier competing risks methods used to estimate time to transplant. Analysis performed per candidate not per listing. Only the first transplant is counted.

data behind the figures can be downloaded from our website, at srtr.transplant.hrsa.gov

8

OPTN/SRTR 2013 Annual Data Report

waiting list 14 18-34 35-49 50+

12 10 8 6 4 2

Race

14 White Black 12 Other/unknown 10 All

12

Deaths per 100 wait-list years

Age Deaths per 100 wait-list years

Deaths per 100 wait-list years

14

10 8 6 4 2

03

05

07 09 Year

11

13

PTA SPK PAK

8 6 4 2

0

0

Intended transplant type

0 03

05

07 09 Year

11

13

03

05

07 09 Year

11

13

PA 1.10 Pretransplant mortality rates among adults waitlisted for pancreas transplant Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Patients concurrently listed at multiple centers are counted once. Deaths after removal from the waiting list are not counted. Age is determined at the later of listing date or January 1 of the given year.

4

On KP list

On PA list Dually listed on KP Transferred to KP

3 Percent

3 Percent

4

Dually listed on PA Transferred after receiving DD KI Transferred after receiving LD KI Transferred without transplant

2 1

2 1

0

0 02

04

06

08 Year

10

12

02

04

06

08

10

12

Year

PA 1.11 List-switching by kidney-pancreas and pancreas-alone waitlist candidates Newly listed kidney-pancreas (KP; left panel) and pancreas-alone (PA; right panel) candidates by listing year. Dual listings, removals from the list, and transfers between lists are followed for 1 year postlisting. Dual listing is defined as waiting for at least 1 day for both KP and PA transplant. Categories are mutually exclusive and exhaustive. The remaining portion of candidates (not shown, approximately 96-97%) were on only one one list during the fist year postlisting. DD, deceased donor; KI, kidney only; LD, living-donor.

9 pancreas

deceased donation Age

20 Donations per 1,000 deaths

Donations per 1,000 deaths

20 15

< 15 15-34 35-44 45-54

10

55-64 65-74 All

5 0

Race White Black Hispanic Asian Other/unknown

15 10

No data

05

07 Year

09

11

03

05

07 Year

09

11

Numerator: Deceased donors aged younger than 75 years with pancreata recovered for transplant. Pancreata reocvered for islet transplant are excluded. Denominator: US deaths per year, age younger than 75 years. Death data available only through 2011. (Death data available at http://www.cdc.gov/nchs/ products/nvsr.htm.)

100

60 40

60

Percent

< 18 18-34 35-49 50+

100 30-< 35 35+ 80 All

< 18.5 kg/m2 18.5-< 25 25-< 30

80 Percent

Percent

80

BMI

40 20

20

03

05

07 09 Year

11

13

Race White Black Other/unknown

60 40 20

0

0

0 03

05

07 09 Year

11

13

03

05

07 09 Year

11

13

PA 2.3 Rates of organs recovered for transplant and not transplanted Percentages of pancreata not transplanted out of all pancreata recovered for transplant. Pancreata recovered for islet transplant are excluded.

4

100

3.5

80 Percent

Percent

3 2.5 2

Anoxia Cerebrovascular/stroke Head trauma CNS tumor Other

60 40 20

1.5

0

1 03

05

07 Year

09

11

13

PA 2.5 DCD pancreas donors Deceased donors whose pancreata were recovered for transplant. Pancreata recovered for islet transplant are excluded.

0.85

03

05

07 Year

09

11

13

PA 2.6 Cause of death among deceased pancreas donors Deceased donors whose pancreass were transplanted. CNS, central nervous system.

data behind the figures can be downloaded from our website, at srtr.transplant.hrsa.gov

Deceased donors residing in the 50 states whose pancreata were recovered for transplant from 2009 through 2011. Pancreata recovered for islet transplant are excluded. Denominator: US deaths, all ages, by state from 2009 through 2011 (death data available at http://www. cdc.gov/nchs/products/nvsr.htm).

Percent of donors with given characteristic

Age

0.68

PA 2.2 Deceased donor pancreas donation rates (per 1000 deaths), by state, 2009-2011

PA 2.1 Deceased donor pancreas donation rates

100

1.01 0.58

5 0

03

0.40 0.49

70

Black race Asian race Female DCD BMI > 25 kg/m2 Age > 28

60 50 40 30 20

CVA death Terminal SCr > 2.5 mg/dl

10 0 03

05

07 Year

09

11

13

PA 2.4 Donor-specific components of the pancreas donor risk index over time Donors whose pancreata were transplanted. The donor-specific components of the pancreas donor risk index (PDRI) are shown, except for donor height. CVA, cerebrovascular accident. SCr, serum creatinine.

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OPTN/SRTR 2013 Annual Data Report

transplant PTA Age

Sex Race

Primary diagnosis

Blood type

BMI (kg/m2 )

Waiting time

1000 PTA SPK PAK All

Insurance

0 03

05

07 Year

09

11

13

Pancreas tx history

PA 3.1 Total pancreas transplants

All recipients

All pancreas transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.

1500

SRTR 2013 Annual Data Report: pancreas.

Pancreas listings and transplants decreased during the past decade, most notably pancreas after kidney transplants. Center-reported outcomes of pancre...
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