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Title: | Outcomes of pancreas transplantation in older diabetic patients |
Author: | Montagud Marrahi, Enrique Molina Andújar, Alícia Pané, Adriana Ramírez-Bajo MJ Amor, Antonio Esmatjes Mompó, Enric Ferrer Fábrega, Joana Musquera i Felip, Mireia Diekmann, Fritz Ventura Aguiar, Pedro |
Keywords: | Diabetis Pàncrees Trasplantament d'òrgans Trasplantament renal Persones grans Malalties cardiovasculars Diabetes Pancreas Transplantation of organs Kidney transplantation Older people Cardiovascular diseases |
Issue Date: | Mar-2020 |
Publisher: | BMJ Publishing Group |
Abstract: | Objective: Improvement in insulin alternatives is leading to a delayed presentation of microvascular and macrovascular complications of diabetes. The objective of this study was to evaluate the long-term outcomes of older (≥50 years) diabetic patients who receive a pancreas transplantation (PT). Research design and methods: We retrospectively evaluated all 338 PTs performed at our center between 2000 and 2016 (mean follow-up 9.4±4.9 years). Recipient and graft survivals were estimated for up to 10 years after PT. Major adverse cardiovascular events (MACEs) before and after PT were included in the analysis. Results: Thirty-nine patients (12%) were ≥50 years old (52.7±2.3 years) at the day of PT, of which 29 received a simultaneous pancreas-kidney transplantation (SPK) and 10 a pancreas after kidney transplantation (PAK). SPK recipients were first transplants, whereas in the PAK up to 50% were pancreas re-transplantations. Recipient and pancreas graft survivals at 10 years were similar between the group <50 years old and the older group for both SPK and PAK (log-rank p>0.05). The prevalence of MACE prior to PT was similar between both groups (31% vs 29%). Following PT, older recipients presented inferior post-transplant MACE-free survival. In a multivariate regression model, diabetes vintage (HR 1.054, p=0.03) and pre-transplantation MACE (HR 1.98, p=0.011), but not recipient age (HR 1.45, p=0.339), were associated with post-transplant MACE. Conclusions: Long-term survival of older pancreas transplant recipients are similar to younger counterparts. Diabetes vintage, but not age, increased the risk of post-transplantation MACE. These results suggest pancreas transplantation is a valuable treatment alternative to older diabetic patients. |
Note: | Reproducció del document publicat a: https://doi.org/10.1136/bmjdrc-2019-000916 |
It is part of: | BMJ Open Diabetes Research & Care, 2020, vol. 8, num. 1, p. e000916 |
URI: | http://hdl.handle.net/2445/195427 |
Related resource: | https://doi.org/10.1136/bmjdrc-2019-000916 |
ISSN: | 2052-4897 |
Appears in Collections: | Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer) Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques) |
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