Guidance on benefits of pancreas after kidney transplantView comments
Sponsoring Committee: Pancreas Transplantation
Strategic Goal: Increase the number of transplants
Guidance on pancreas after kidney transplant benefits (PDF - 505 K; 12/2017)
Pancreas Committee Board briefing paper - guidance (PDF - 525 K; 12/2017)
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.
Read the full proposal (PDF - 518 K)
- Very small: UNOS implementation effort for all departments
- Minimal member implementation impact: Staff time to develop strategy and patient education
- Pancreas volume accounts for small percentage of transplants.
- One month or less to implement for hospitals
- Guidance documents do not contain new member requirements. However, the assumption in estimating fiscal impact is the members will follow guidelines.
Implementation and ongoing effort among all departments is very small.
- Hospital: Implementation of this guidance is minimal, and includes only staff time to develop strategy and patient education. There may be additional cost to evaluate and list candidates. Costs incurred should be reimbursable. Most hospitals with an existing pancreas program already offer pancreas after kidney transplant as a treatment option. The only variable that could cause a fiscal impact would be increased transplant volume. This is unlikely, however, since pancreas does not account for a large percentage of all transplants.
- OPO and Lab: No impact.