Influence Of Duration Of Type 1 Diabetes On Pancreatic Transplant Outcomes

Background and Objective:Pancreas transplantation is currently the only possible treatment to cure type 1diabetes mellitus(T1DM).There are many factors impacting the prognosis of pancreas transplants.However,there are no multicenter studies on the influence of diabetes duration on pancreas transplant outcomes.Our study aimed to determine how T1 DM duration influenced pancreas transplant outcomes based on a multicenter organ transplant database.Methods:The data of 8,139 T1 DM patients received pancreas transplants during 2006–2015were extracted from the Scientific Registry of Transplant Recipients(SRTR)database.Patients were separated into two groups according to duration of diabetes: S group(diabetes ≤20 years)and L group(>20 years).The Kaplan-Meier curves were used to compare patient and pancreas graft survival between the two groups.Cox regression analysis was adopted to identify predictors of post-transplant outcomes.The patients were further divided into three subgroups by category of transplantation: pancreastransplant alone(PTA),pancreas after kidney transplant(PAK),and simultaneous pancreas-kidney transplant(SPK).Stratified analyses were performed to clarify whether T1 DM duration was associated with post-transplant outcomes in each type of pancreas transplant.Results:Compared to patients in S group,patients in L group were older and prone to be male,to have slightly higher BMI,to receive PAK,and had a larger ethnic proportion of White but less Black.Donor characteristics were all comparable between the S group and the L group.No statistically significant difference was observed in patient survival between the two groups.However,longer duration of T1 DM was identified to be an independent protective factor for better pancreatic graft survival(HR = 0.88,p = 0.012).In subgroup analyses,there is no significant difference in patient survival between S and L group in each category of pancreas transplant.Recipients with longer diabetic duration enjoyed better pancreatic graft survival in PTA and SPK.While pancreatic graft survival of S group was not different from L group in PAK.Notably,longer diabetes duration was an independent protective predictor of pancreas graft survival in SPK patients(HR = 0.86,p = 0.012).Conclusions:Diabetes duration has no influence on patient survival.However,long duration of T1 DM appears to be protective against pancreatic graft loss.