Older age may not compromise pancreas transplant outcomes
medwireNews: The success of a pancreas transplant is not significantly affected by the age of the recipient, say Spanish researchers.
And although older transplant recipients in their study were more likely than younger patients to have a post-transplant major adverse cardiovascular event (MACE), age itself was not an independent contributor to this risk, they report in BMJ Open Diabetes Research & Care.
Pedro Ventura-Aguiar (Hospital Clinic de Barcelona) and team studied 338 pancreas transplant recipients with an average follow-up of 9.4 years. These included 39 (12%) who were aged 50 years or older. The researchers observe that improved management options for type 1 diabetes over recent years has led to a general increase in the age at which people with diabetes are referred for a pancreatic transplant.
Before transplantation, MACE rates were similar for both age groups, at 33% and 29% for the older and younger patients, respectively, but the corresponding rates after transplantation were 31% versus 20%, and the older group had a significantly lower MACE-free survival at 1, 5, and 10 years than the younger group, at 92.9% versus 96.5%, 70.3% versus 91.1%, and 70.3% versus 78.0%.
Fifty percent (two of four) deaths in the older group were attributed to MACE, whereas infection was the most common cause of mortality in the younger patients, accounting for 44% of deaths.
Nevertheless, age per se was not associated with MACE risk in multivariate analysis. Instead, longer diabetes duration and having had a MACE prior to transplantation were independently associated with post-transplant MACE risk, with the latter almost doubling the risk.
And despite these differences, the overall survival rates among patients who had a simultaneous pancreas–kidney transplantation (the majority, at 74–84%) were similar for both age groups, at 96.6%, 89.3%, and 89.3% after 1, 5, and 10 years, respectively, in the older patients, with corresponding rates of 98.4%, 95.8%, and 95.8% in the younger patients.
Likewise, the graft survival rates after accounting for mortality were 89.0%, 81.9%, and 76.0% in the younger group at 12 months, 5 years, and 10 years, respectively, and 89.7% at all three timepoints in the older patients.
There were no notable differences in rates of acute rejection or post-transplant complications, or in the time spent in hospital, and the transplants were equally successful for both age groups in terms of glycated hemoglobin and C-peptide levels. Findings were similar for the smaller group of patients who underwent pancreas transplant following a kidney transplant.
The researchers say their findings highlight the need for “careful recipient selection and thorough cardiovascular evaluation prior to transplantation, particularly in those with a MACE prior to transplantation.”
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