There has been a substantial decline in Pancreas After Kidney (PAK) transplants for more than a decade. PAK transplants have dropped steadily each year, with a 55% decrease from 2004 to 2011, even while 2-year pancreas graft survival increased for PAKs from 69% to 81% for the same time period.¹ PAK transplantation has historically been associated with inferior pancreas allograft survival compared with Simultaneous Pancreas and Kidney (SPK) transplantation. The Pancreas Committee sought to compare PAK transplants with SPK candidates and kidney alone recipients waiting for a pancreas to examine what characteristics resulted in improved outcomes for PAK recipients and to address an influential previous study that demonstrated poor outcomes for PAK recipients.

UNOS research analysis showed that PAK transplant recipients have an increased survival advantage compared to SPK waiting list candidates who receive neither a pancreas nor a kidney. Moreover, compared to uremic diabetic waitlist candidates, SPK and PAK recipients showed similar patient survival benefits. Finally, the analysis showed that both living and deceased donor kidney recipients who subsequently receive a pancreas transplant have better kidney graft survival than those recipients who just received a kidney alone. While the analysis does not include recipients that had a kidney graft loss before the pancreas transplant, which can bias the results to those healthy enough to get a PAK that are included in the PAK group, the results still indicate that PAK transplants are appropriate for certain diabetic uremic candidates, especially those with long SPK waiting list times. The Committee seeks to provide guidance to the community on the benefits of PAK transplants for these candidates.

¹ Gruessner, A.c., and R.w.g. Gruessner. "Declining Numbers of Pancreas Transplantations but Significant Improvements in Outcome." Transplantation Proceedings 46, no. 6 (August 2014): 1936-937. doi:10.1016/j.transproceed.2014.06.045.