Ngan N Lam1, Mark A Schnitzler, Dorry L Segev, Gregory P Hess, Bertram L Kasiske, Henry B Randall, David Axelrod, Huiling Xiao, Amit X Garg, Daniel C Brennan, Krista L Lentine. 1. 1 Division of Nephrology, University of Alberta, Edmonton, AB, Canada. 2 Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO. 3 Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD. 4 Symphony Health Solutions, Leonard Davis Institute for Health Economics, Philadelphia, PA. 5 Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA. 6 Division of Nephrology, Department of Medicine, Hennepin County Medical Center, Minneapolis, MN. 7 Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN. 8 Division of Abdominal Transplantation, Department of Surgery, Brody School of Medicine, Greenville, NC. 9 Division of Nephrology, Western University, London, ON, Canada. 10 Transplant Nephrology, Washington University School of Medicine, St. Louis, MO.
Abstract
BACKGROUND: Living donor pancreas transplant is a potential treatment for diabetic patients with end-organ complications. Although early surgical risks of donation have been reported, long-term medical outcomes in living pancreas donors are not known. METHODS: We integrated national Scientific Registry of Transplant Recipients data (1987-2015) with records from a nationwide pharmacy claims warehouse (2005-2015) to examine prescriptions for diabetes medications and supplies as a measure of postdonation diabetes mellitus. To compare outcomes in controls with baseline good health, we matched living pancreas donors to living kidney donors (1:3) by demographic traits and year of donation. RESULTS: Among 73 pancreas donors in the study period, 45 were identified in the pharmacy database: 62% women, 84% white, and 80% relatives of the recipient. Over a mean postdonation follow-up period of 16.3 years, 26.7% of pancreas donors filled prescriptions for diabetes treatments, compared with 5.9% of kidney donors (odds ratio, 4.13; 95% confidence interval, 1.91-8.93; P = 0.0003). Use of insulin (11.1% vs 0%) and oral agents (20.0% vs 5.9%; odds ratio, 4.50, 95% confidence interval, 2.09-9.68; P = 0.0001) was also higher in pancreas donors. CONCLUSIONS: Diabetes is more common after living pancreas donation than after living kidney donation, supporting clinical consequences from reduced endocrine reserve.
BACKGROUND: Living donor pancreas transplant is a potential treatment for diabeticpatients with end-organ complications. Although early surgical risks of donation have been reported, long-term medical outcomes in living pancreas donors are not known. METHODS: We integrated national Scientific Registry of Transplant Recipients data (1987-2015) with records from a nationwide pharmacy claims warehouse (2005-2015) to examine prescriptions for diabetes medications and supplies as a measure of postdonation diabetes mellitus. To compare outcomes in controls with baseline good health, we matched living pancreas donors to living kidney donors (1:3) by demographic traits and year of donation. RESULTS: Among 73 pancreas donors in the study period, 45 were identified in the pharmacy database: 62% women, 84% white, and 80% relatives of the recipient. Over a mean postdonation follow-up period of 16.3 years, 26.7% of pancreas donors filled prescriptions for diabetes treatments, compared with 5.9% of kidney donors (odds ratio, 4.13; 95% confidence interval, 1.91-8.93; P = 0.0003). Use of insulin (11.1% vs 0%) and oral agents (20.0% vs 5.9%; odds ratio, 4.50, 95% confidence interval, 2.09-9.68; P = 0.0001) was also higher in pancreas donors. CONCLUSIONS:Diabetes is more common after living pancreas donation than after living kidney donation, supporting clinical consequences from reduced endocrine reserve.
Authors: David E R Sutherland; David Radosevich; Rainer Gruessner; Angelika Gruessner; Raja Kandaswamy Journal: Curr Opin Organ Transplant Date: 2012-02 Impact factor: 2.640
Authors: Krista L Lentine; Mark A Schnitzler; Amit X Garg; Huiling Xiao; David Axelrod; Janet E Tuttle-Newhall; Daniel C Brennan; Dorry L Segev Journal: Am J Nephrol Date: 2014-09-02 Impact factor: 3.754
Authors: Macey L Henderson; Sandra R DiBrito; Alvin G Thomas; Courtenay M Holscher; Ashton A Shaffer; Mary Grace Bowring; Tanjala S Purnell; Allan B Massie; Jacqueline M Garonzik-Wang; Madeleine M Waldram; Krista L Lentine; Dorry L Segev Journal: Transplantation Date: 2018-07 Impact factor: 4.939