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Pancreas

OPTN/SRTR 2016 Annual Data Report: Pancreas

Abstract

The number of pancreas transplants performed in the United States increased by 7.0% in 2016 over the previous year, the first such increase in more than a decade, largely attributable to an increase in simultaneous kidney pancreas transplants. Transplant rates increased in 2016, and mortality on the waiting list decreased. The declining enthusiasm for pancreas after kidney (PAK) transplants persisted. The uniform definition of graft failure was approved by the OPTN Board of Directors in 2015 and will be implemented in early 2018. Meanwhile, SRTR continues to refrain from reporting pancreas graft failure data. The OPTN/UNOS Pancreas Transplantation Committee is seeking to broaden allocation of pancreata across compatible ABO blood types in a proposal out for public comment July 31 to October 2, 2017. A new initiative to provide guidance on the benefits of PAK transplants is also out for public comment.

Introduction

The effect of the new pancreas allocation scheme, implemented in October 2014, remained evident in transplant patterns in 2016. The proportion of simultaneous kidney pancreas (SPK) candidates with type 2 diabetes increased to 11.7% (Table PA 2) from 10.5% in 2015 (data from 2015 ADR, Table PA 1), contributing to the overall increase in numbers of pancreas transplants. The OPTN Pancreas Transplantation Committee is reviewing the body mass index (BMI) limit for C peptide positive, active SPK candidates to accrue waiting time, to consider recommending a further increase.

The lack of enthusiasm for pancreas after kidney (PAK) transplants continued, and the OPTN/UNOS Pancreas Transplantation Committee began a new initiative to provide guidance on increasing them. A systematic review of the literature and current outcomes followed by discussion in the committee is underway. A guidance paper is out for public comment July 31 to October 2, 2017, and is expected to go to the OPTN Board of Directors for approval in December 2017.

If approved, the forthcoming proposal to increase local use of pancreata by prioritizing blood group compatibility rather than blood group match in the local algorithm before regional and national sharing could improve use of donor pancreata. This proposal, titled Broadened Allocation of Pancreas Transplantation Across Compatible ABO Blood Types, is also out for public comment July 31 to October 2, 2017, and is expected to go to the OPTN Board of Directors for approval in December 2017.

Transplant rates increased in 2016 (Figure PA 12), while waitlist mortality decreased (Figure PA 22). Overall patient survival improved. These observations suggest that programs were listing selectively, and performing transplants more efficiently with better outcomes. In keeping with this trend toward decreased risk taking, the average pancreas donor risk index (PDRI) remained lower than the average PDRI 10 years prior.

Waitlist additions did not keep pace with increased transplant numbers, raising the question whether the increase is sustainable. This is especially relevant with alternative therapies on the horizon. As of August 2017, the Biologics License Application for islet transplantation is pending with the US Food and Drug Administration, and a closed loop insulin pump was recently introduced in the market. The outcomes of pancreas transplant in relation to emerging therapies should be determined with comparative clinical trials to ensure proper positioning for continued application of pancreas transplant in the future.

Waiting List

In 2016, 957 adult pancreas transplant candidates were newly listed as active (Figure PA 1); 1429 were newly listed overall (active and inactive) (Figure PA 2), the lowest numbers in their categories over the past decade. The proportion of active candidates increased slightly to 67.0% of all candidates, from 65.1% in 2015, the highest proportion since 2008. Active prevalent listings decreased to 1065 in 2016 from 1211 in 2015 (Figure PA 3), and total listings decreased to 2461 in 2016 from 2732 in 2015 (Figure PA 4). Both numbers are historically low, due to fewer new listings and more transplants.

The proportion of older candidates (aged > 50 years) increased slightly to 26.2%, continuing a trend of gradual increases over time, dating back to 19.1% in 2005 (Figure PA 5). The proportion of white candidates steadily decreased from 75.7% in 2005 to 61.7% in 2016, with corresponding increases in proportions of black, Hispanic, and Asian candidates (Figure PA 6).

The proportion of candidates with type 2 diabetes increased slightly from 9.1% in 2015 to 9.9% in 2016 (Figure PA 7). Waiting time remained mostly unchanged over the past 5 years; 41.8% of candidates on the waiting list in 2016 had been waiting less than 1 year and 34.2% had been waiting between 1 and 3 years in 2016 (Figure PA 8). This demonstrates a lack of impact, at least in the short term, of the new pancreas allocation policy on waiting times. The proportion of obese candidates (BMI ≥ 30 kg/m2) increased from 15.1% in 2005 to 18.7% in 2016 (Figure PA 9), but remained largely stable over the past 4 years. The proportion of PAK candidates was 12.5% of the total in 2016, the lowest since 2005. SPK listings, at 72.9% in 2016, have increased proportionally over the past decade, from 64.2% in 2005 (Figure PA 10).

Transplant rates for active candidates with type 2 diabetes increased to 118.1 per 100 waitlist years in 2016, up markedly from 90.7 in 2015, and progressively increased from 46.5 in 2005. Transplant rates for candidates with type 1 diabetes also increased, to 79.2 per 100 waitlist years, from 67.9 in 2015 and 65.5 in 2005 (Figure PA 11). Transplant rates for all types of transplants improved, leading to an overall rate of 82.9 per 100 waitlist years, greatly improved from 71.5 in 2015 and 65.3 in 2005 (Figure PA 12). An increase in deceased donors whose organs were recovered for transplant likely contributed to this (data not shown), although improved waitlist management may also play a role.

Waitlist outcomes for all categories are shown in Figure PA 13, Figure PA 14, and Figure PA 15. Among candidates listed in 2013, 56.7% of SPK candidates, 55.6% of pancreas transplant alone (PTA; i.e., pancreas transplant without kidney) candidates, and only 38.8% of PAK candidates had undergone deceased donor transplant in 3 years. In fact, high proportions of PAK (28.8%) and PTA (21.8%) candidates were removed from the list by 3 years. Reluctance to take risks in solitary pancreas transplants, especially PAKs, is demonstrable. Median months to transplant were 16.6 for SPK, 18.2 for PTA, and not calculated for PAK since less than 50% of the cohort had undergone transplant (Figure PA 16).

The percentage of candidates listed in 2014 who underwent transplant within 2 years varied widely by donation service area, from 0% to 100%, reflecting geographic disparities (Figure PA 17, Figure PA 18, Figure PA 19). This is despite median months to transplant consistently under 2 years nationally, at least for SPK and PTA, since 2005.

Pretransplant mortality rates decreased consistently over the years to 4.4 per 100 waitlist years in 2016, compared with 6.5 in 2005 (Figure PA 22). Of note, mortality in older patients (aged > 50 years) markedly decreased to 4.6 in 2016, from 6.7 in 2015 (Figure PA 20). Mortality was highest for black patients, 6.4 in 2016 (Figure PA 21), and for the SPK transplant type, as expected, at 5.7 (Figure PA 22). In the 2015-2016 cohort, geographic differences in pretransplant mortality rates were evident; rates ranged from 0 to 15.3 per 100 waitlist years (Figure PA 23). Deaths within 6 months of removal from the waiting list were 4.1% overall and lowest, 0%, for PAK candidates (Figure PA 24).

Donation

No living donor pancreas transplants were reported in 2016. Proportions of deceased pancreas donors aged 35 years or older steadily decreased since 2009, with a corresponding increase in donors aged younger than 35 years. The proportion of older donors (aged > 50 years) decreased to below 1% of the total recovered donor pool (Figure PA 25). By race/ethnicity, white donors predominated at 64.3% in 2016. No appreciable trends were noted in black or Hispanic donor populations (Figure PA 26).

Figure PA 27 shows a map of deceased donor pancreas donation rates by state, 2013-2015. Overall, 1.4 pancreata per 1000 deaths were recovered for transplant (range 0-3.41). Higher recovery rates were more likely in the Midwest. Discard rates of pancreata recovered for transplant were highest, as expected, for donors aged ≥ 50 years (81.8% in 2016) (Figure PA 28). Analysis by race showed no noteworthy trends in discard rates (Figure PA 29). Discard rates were higher for donors with high BMI, 46.5% for BMI 30-34.9 kg/m2 and 57.1% for BMI ≥ 35 kg/m2. Overall, discard rates for pancreata recovered for transplant remained high, at 24.0% in 2016 (Figure PA 30).

Average calculated PDRI showed a general decreasing trend over the past decade in all transplant categories. Overall PDRI was 1.06 in 2016, with PAK at 0.98, PTA at 1.02 and SPK at 1.07 (Figure PA 32). PDRI for PAK donors was the lowest in the reported decade.

Anoxia as a cause of death in pancreas donors continued to increase, accounting for 32.6% of donors in 2016, up from 26.4% in 2015 and 10.9% in 2005. This may be related to the increasing incidence of deaths from drug overdoses in the country. The proportion of cerebral vascular accident/stroke deaths decreased to 9.7% in 2016, from 10.6% in 2015 and 17.4% in 2005. This is in keeping with the decreasing proportion of older donors. Head trauma as a cause of death also decreased, at 54.0% in 2016, down from 60.8% in 2015 and 69.7% in 2005 (Figure PA 33).

Transplant

The overall number of pancreas transplants increased to more than 1000 for the first time in several years, approximating the number performed in 2013. The reasons for the increase may be varied, and it will be important to see if this upward trend continues. The increases were in the SPK category, whereas numbers of solitary pancreas transplants (PAK, PTA) were stable (Figure PA 34). The increases in numbers of SPKs may in part reflect changes in the national pancreas allocation scheme. Under the new algorithm, if a pancreas is suitable for transplant, waiting time drives allocation, and SPK and solitary pancreas candidates are treated equally. The kidney donor profile index (KDPI) of the kidney allocated with the pancreas is usually low, reflecting the overall high quality of donors whose pancreata are suitable for transplant. Waiting times for pancreas transplants are substantially shorter than for kidney transplants, and this combined with low KDPI (high quality) of the donor organs may encourage programs to perform more SPKs.

The demographics of patients who underwent transplant in 2016 were consistent with a more aggressive approach by pancreas transplant programs. The greatest increase was among older recipients (aged ≥ 50 years); numbers of transplants performed increased from 185 in 2015 to 240 in 2016 (Figure PA 35). Likewise, the greatest increase by recipient BMI was in the higher BMI range; the number of pancreas recipients with a BMI of 28-29.9 kg/m2 increased from 95 to 124, and the number with a ≥ BMI 30 kg/m2 increased from 105 to 138 (Figure PA 39). The risk/benefit ratio for higher BMI and older pancreas transplant recipients favored kidney alone transplants in this higher-risk group. However, with waiting times for kidney transplants twice as long as for pancreas transplants in many geographic areas, the risks of longer dialysis time shifted the risk/benefit ratio, resulting in a greater advantage for SPK transplant in the higher-risk groups.

In 2016, the number of type 2 diabetic patients undergoing transplant increased from 71 to 105 (Figure PA 38). This substantial increase may also indicate a more aggressive approach to performing pancreas transplants in recipients who routinely received kidney transplants alone. Again, this may be driven by the substantially shorter waiting times for SPKs than for kidney transplant alone. The increase in the number of transplants being performed in type 2 diabetic recipients may be responsible for the increases in the number of higher-BMI transplants.

Recipients of pancreas transplants continued to be predominately men in 2016, although the male/female ratio did not change (Figure PA 36). In 2016, for the first time, over 200 pancreas transplants were performed in black recipients, a growing demographic in pancreas transplantation over the past 5 years. The number of white recipients increased for first time in over a decade (Figure PA 37).

Immunosuppression trends did not change notably over the past few years, although use of more aggressive induction with T-cell-depleting regimens continued to increase. In 2016, 84.8% of immunosuppressive regimens used some form of lymphocyte depletion (Figure PA 40), the highest rate in the past decade. The ongoing increasing trend toward more potent induction likely represents the broad national experience with finding the best strategy to minimize rejection rates to overcome both alloimmune and autoimmune response. Despite the known nephrotoxicity and diabetocenicity of tacrolimus, it has evolved to become the calcineurin inhibitor of choice, with 95.5% of programs reporting its use in maintenance therapy (Figure PA 41). Likewise, mycophenolate has become the anti-proliferative agent of choice, with 94.0% of programs reporting its use in maintenance therapy (Figure PA 42). Use of mTOR inhibitors remained constant at approximately 9%-10% at 1 year. Low use of mTOR inhibitors at the time of transplant was likely related to concerns about wound healing, and most programs only institute this agent at 1 month after transplant (Figure PA 43). Despite earlier trends toward maintaining pancreas transplant recipients on steroid-free regimens, 72.5% of recipients were on steroid maintenance at 1 year (Figure PA 44).

The proportion of unsensitized SPK recipients (calculated panel-reactive antibodies, [cPRA] < 1%) remained relatively constant over the past few years, with 71.3% unsensitized in 2016 (Figure PA 47). Of note, proportions of moderately sensitized recipients with cPRA 20%-79% increased in all categories, particularly PAK (Figure PA 45, Figure PA 46, Figure PA 47).

Most pancreas transplant recipients had 5 or 6 HLA mismatches (Figure PA 48), consistent with historical data demonstrating that HLA matching is less important in pancreas transplantation. Although HLA matching may be beneficial with regard to minimizing the alloimmune response, there is speculation that matching is potentially disadvantageous with regard to protecting against the autoimmune response in type 1 diabetic recipients. This dichotomy is likely responsible for the relative lack of enthusiasm for HLA matching in pancreas transplant recipients.

Outcomes

In 2016, the definition of pancreas graft failure remains subject to variation by program. Some programs do not report a failed graft if C peptide production continues, whereas others report a graft failure if the recipient is no longer insulin independent. Because of this variation in reporting, any reports of graft outcomes should be considered with caution. That being said, the program-reported early pancreas graft failure rate remained stable over the past 5 years, and in 2016 was 8.3% for PAK, 9.4% for PTA, and 8.0% for SPK (Figure PA 51). The OPTN/UNOS Pancreas Transplantation Committee has provided more precise definitions for pancreas graft failure, and once these are implemented, the pancreas graft outcome data reported to SRTR will carry more weight. The Office of Management and Budget recently approved the new pancreas graft failure definition, and implementation should take place in early 2018.

Despite the current variability in reporting pancreas graft outcomes, the data available for kidney transplant graft outcomes associated with SPK and PAK are accurate. All-cause kidney graft failure rates after SPK at 1, 5, and 10 years for the most recent cohort were 3.1%, 16.5%, and 37.7%, respectively (Figure PA 52). This continued to compare favorably with non-SPK deceased donor kidney transplants, and undoubtedly reflected the lower-KDPI kidneys used in SPK. All-cause deceased donor kidney graft failure rates after PAK were 3.3%, 21.2% and 51.2% at 1, 5, and 10 years, respectively (Figure PA 54); corresponding all-cause living donor kidney failure rates were 3.0%, 13.7%, and 37.0%, respectively (Figure PA 56). The kidney outcomes for PAK were from the time of pancreas transplant, which helps account for the lower survival rates compared to those of SPK recipients. Death-censored kidney graft failure rates for SPK are shown in Figure PA 53, and for deceased and living donor kidneys after PAK in Figure PA 55 and Figure PA 57, respectively.

The number of recipients alive after pancreas transplant continued to rise, with 18,184 reported in 2016 (Figure PA 58). Incidence of acute rejection in the first year following pancreas transplant continued to decrease for SPK and PTA in 2014-2015, but increased for PAK, reported at 12.3%, 16.5%, and 18.3% respectively (Figure PA 59). Although rejection rates for SPK recipients were less than 15% for several years, the marked improvement in rejection rates for PTA is impressive, and down from the 21.8% reported for PTAs performed in 2010-2011 (Figure PA 59). This reflects ongoing improvement in immunosuppression protocols to prevent rejection in this pre-uremic group of recipients who had previously been at significantly increased risk of rejection.

The increased immunosuppression used to achieve the low rejection rates is reflected in the relatively high cumulative incidence of lymphoproliferative disorder in pancreas transplant recipients. The cumulative incidence was highest for PTA, reported at 5.6% for Epstein-Barr virus (EBV)-naive recipients (Figure PA 61). Incidence for SPK and PAK in EBV-naive recipients was 3.0% and 2.0%, respectively (Figure PA 62, Figure PA 60).

Although pancreas allograft survival rates depend on program-reported graft failure, patient survival data are accurate. Five- and 10-year mortality decreased consistently among all pancreas transplant groups (Figure PA 64, Figure PA 65), reflecting increased experience and safer and more effective immunosuppressive regimens. One-year mortality for PTA declined from 4.6% in 2012-2013 to 0.8% for transplants performed in 2014-2015, and was consistent with better overall results observed in this challenging category of pancreas transplants. Finally, the 5-year patient survival rates for pancreas transplants performed in 2009-2011 were similar for SPK, PAK, and PTA (89.2%-91.0%, Figure PA 66). Similarly, 5-year survival rates for transplants in recipients with type 1 and type 2 diabetes performed in 2009-2011 were similar (90.5% and 91.5% respectively), despite the older age and comorbidity associated with type 2 diabetes (Figure PA 67). This is likely due to selecting candidates with type 2 diabetes whose cardiovascular status can tolerate the high operative risks associated with pancreas transplantation.

Figure List

Waiting list

Figure PA 1. New adult candidates added to the active pancreas transplant waiting list
Figure PA 2. New adult candidates added to the pancreas transplant waiting list
Figure PA 3. Adults actively listed for pancreas transplant on December 31 each year
Figure PA 4. Adults listed for pancreas transplant on December 31 each year
Figure PA 5. Distribution of adults waiting for pancreas transplant by age
Figure PA 6. Distribution of adults waiting for pancreas transplant by race
Figure PA 7. Distribution of adults waiting for pancreas transplant by diagnosis
Figure PA 8. Distribution of adults waiting for pancreas transplant by waiting time
Figure PA 9. Distribution of adults waiting for pancreas transplant by BMI
Figure PA 10. Distribution of adults waiting for pancreas transplant by intended transplant type
Figure PA 11. Deceased donor pancreas transplant rates among active adult waitlist candidates by diagnosis
Figure PA 12. Deceased donor pancreas transplant rates among active adult waitlist candidates by intended transplant type
Figure PA 13. Three-year outcomes for adults waiting for pancreas after kidney transplant, new listings in 2013
Figure PA 14. Three-year outcomes for adults waiting for pancreas transplant alone, new listings in 2013
Figure PA 15. Three-year outcomes for adults waiting for simultaneous kidney-pancreas transplant, new listings in 2013
Figure PA 16. Median months to pancreas transplant for waitlisted adults
Figure PA 17. Percentage of adults who underwent pancreas after kidney transplant within 2 years of listing in 2014 by DSA
Figure PA 18. Percentage of adults who underwent pancreas transplant alone within 2 years of listing in 2014 by DSA
Figure PA 19. Percentage of adults who underwent simultaneous kidney-pancreas transplant within 2 years of listing in 2014 by DSA
Figure PA 20. Pretransplant mortality rates among adults waitlisted for pancreas transplant by age
Figure PA 21. Pretransplant mortality rates among adults waitlisted for pancreas transplant by race
Figure PA 22. Pretransplant mortality rates among adults waitlisted for pancreas transplant by intended transplant type
Figure PA 23. Pretransplant mortality rates among adults waitlisted for pancreas transplant in 2015-2016, by DSA
Figure PA 24. Deaths within six months after removal among adult pancreas waitlist candidates

Deceased donation

Figure PA 25. Deceased pancreas donors by age
Figure PA 26. Deceased pancreas donors by race
Figure PA 27. Deceased donor pancreas donation rates (per 1000 deaths) by state, 2013-2015
Figure PA 28. Rates of pancreata recovered for transplant and not transplanted by age
Figure PA 29. Rates of pancreata recovered for transplant and not transplanted by race
Figure PA 30. Rates of pancreata recovered for transplant and not transplanted by BMI
Figure PA 31. Donor-specific components of the pancreas donor risk index
Figure PA 32. Average pancreas donor risk index
Figure PA 33. Cause of death among deceased pancreas donors

Transplant

Figure PA 34. Total pancreas transplants
Figure PA 35. Total pancreas transplants by age
Figure PA 36. Total pancreas transplants by sex
Figure PA 37. Total pancreas transplants by race
Figure PA 38. Total pancreas transplants by diagnosis
Figure PA 39. Total pancreas transplants by body mass index (BMI)
Figure PA 40. Induction agent use in adult pancreas transplant recipients
Figure PA 41. Calcineurin inhibitor use in adult pancreas transplant recipients
Figure PA 42. Anti-metabolite use in adult pancreas transplant recipients
Figure PA 43. mTOR inhibitor use in adult pancreas transplant recipients
Figure PA 44. Steroid use in adult pancreas transplant recipients
Figure PA 45. C/PRA at time of transplant in adult recipients of pancreas after kidney transplant
Figure PA 46. C/PRA at time of transplant in adult recipients of pancreas transplant alone
Figure PA 47. C/PRA at time of transplant in adult recipients of simultaneous kidney-pancreas transplant
Figure PA 48. Total HLA A, B, and DR mismatches among adult pancreas transplant recipients, 2012-2016
Figure PA 49. Annual adult pancreas transplant center volumes, by percentile
Figure PA 50. Distribution of adult pancreas transplants by percentile of center volume

Outcomes

Figure PA 51. Graft failure within the first 90 days posttransplant among adult pancreas transplant recipients
Figure PA 52. Graft failure of the kidney among adult SPK transplant recipients
Figure PA 53. Death censored graft failure of the kidney among adult SPK transplant recipients
Figure PA 54. Kidney graft failure among adult PAK transplant recipients with a deceased donor kidney (from time of pancreas transplant)
Figure PA 55. Death-censored kidney graft failure among adult PAK transplant recipients with a deceased donor kidney (from time of pancreas transplant)
Figure PA 56. Kidney graft failure among adult PAK transplant recipients with a living donor kidney (from time of pancreas transplant)
Figure PA 57. Death-censored kidney graft failure among adult PAK transplant recipients with a living donor kidney (from time of pancreas transplant)
Figure PA 58. Recipients alive after pancreas transplant on June 30 of the year, by age at transplant
Figure PA 59. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by transplant type
Figure PA 60. Incidence of PTLD among adult recipients of pancreas after kidney transplant by recipient EBV status at transplant, 2004-2014
Figure PA 61. Incidence of PTLD among adult recipients of pancreas transplant alone by recipient EBV status at transplant, 2004-2014
Figure PA 62. Incidence of PTLD among adult recipients of simultaneous kidney-pancreas transplant by recipient EBV status at transplant, 2004-2014
Figure PA 63. Patient death at one year among adult pancreas transplant recipients
Figure PA 64. Patient death at five years among adult pancreas transplant recipients
Figure PA 65. Patient death at ten years among adult pancreas transplant recipients
Figure PA 66. Patient survival among adult deceased donor pancreas transplant recipients, 2011, by transplant type
Figure PA 67. Patient survival among adult deceased donor pancreas transplant recipients, 2011, by primary diagnosis

Table List

Waiting list

Table PA 1. Demographic characteristics of adults on the pancreas transplant waiting list on December 31, 2016
Table PA 2. Clinical characteristics of adults on the pancreas transplant waiting list on December 31, 2016
Table PA 3. Listing characteristics of adults on the pancreas transplant waiting list on December 31, 2016
Table PA 4. Transplant waitlist activity among adults waiting for a pancreas after kidney transplant
Table PA 5. Transplant waitlist activity among adults waiting for a pancreas transplant alone
Table PA 6. Transplant waitlist activity among adults waiting for a simultaneous kidney pancreas transplant
Table PA 7. Removal reason among adults waiting for pancreas after kidney transplant
Table PA 8. Removal reason among adults waiting for pancreas transplant alone
Table PA 9. Removal reason among adults waiting for simultaneous kidney-pancreas transplant

Transplant

Table PA 10. Demographic characteristics of adult pancreas transplant recipients, 2016
Table PA 11. Clinical characteristics of adult pancreas transplant recipients, 2016
Table PA 12. Transplant characteristics of adult pancreas transplant recipients, 2016
Table PA 13. Adult pancreas donor-recipient serology matching, 2012-2016

A line plot for new adult candidates added to the active pancreas transplant waiting list; the pak category decreases by 84.7% from 313 candidates at 2005 to 48 candidates at 2016; the pta category decreases by 50.5% from 222 candidates at 2005 to 110 candidates at 2016; the spk category decreases by 37.8% from 1284 candidates at 2005 to 799 candidates at 2016; and the all category decreases by 47.4% from 1819 candidates at 2005 to 957 candidates at 2016.

Figure PA 1. New adult candidates added to the active pancreas transplant waiting list
A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. PAK, pancreas after kidney; PTA, pancreas transplant alone; SPK, simultaneous kidney pancreas transplant.


A line plot for new adult candidates added to the pancreas transplant waiting list; the pak category decreases by 74.9% from 486 candidates at 2005 to 122 candidates at 2016; the pta category decreases by 34.8% from 293 candidates at 2005 to 191 candidates at 2016; the spk category decreases by 31.8% from 1637 candidates at 2005 to 1116 candidates at 2016; and the all category decreases by 40.9% from 2416 candidates at 2005 to 1429 candidates at 2016.

Figure PA 2. New adult candidates added to the pancreas transplant waiting list
A new candidate is one who first joined the list during the given year, without having been listed in a previous year. Previously listed candidates who underwent transplant and subsequently relisted are considered new. Candidates concurrently listed at multiple centers are counted once. PAK, pancreas after kidney; PTA, pancreas transplant alone; SPK, simultaneous kidney pancreas transplant.


A line plot for adults actively listed for pancreas transplant on december 31 each year; the pak category decreases by 79.3% from 333 candidates at 2005 to 69 candidates at 2016; the pta category decreases by 33.0% from 182 candidates at 2005 to 122 candidates at 2016; the spk category decreases by 42.6% from 1522 candidates at 2005 to 874 candidates at 2016; and the all category decreases by 47.7% from 2037 candidates at 2005 to 1065 candidates at 2016.

Figure PA 3. Adults actively listed for pancreas transplant on December 31 each year
Candidates concurrently listed at multiple centers are counted once. Those with concurrent listings and active at any program are considered active. PAK, pancreas after kidney; PTA, pancreas transplant alone; SPK, simultaneous kidney pancreas transplant.


A line plot for adults listed for pancreas transplant on december 31 each year; the pak category decreases by 62.4% from 965 candidates at 2005 to 363 candidates at 2016; the pta category decreases by 22.6% from 482 candidates at 2005 to 373 candidates at 2016; the spk category decreases by 28.0% from 2397 candidates at 2005 to 1725 candidates at 2016; and the all category decreases by 36.0% from 3844 candidates at 2005 to 2461 candidates at 2016.

Figure PA 4. Adults listed for pancreas transplant on December 31 each year
Candidates concurrently listed at multiple centers are counted once. PAK, pancreas after kidney; PTA, pancreas transplant alone; SPK, simultaneous kidney pancreas transplant.


A line plot for distribution of adults waiting for pancreas transplant by age; the 18 to 34 category is 20.6 percent at 2005 and remains relatively constant with a value of 20.9 percent at 2016; the 35 to 49 category decreases by 12.2% from 60.2 percent at 2005 to 52.9 percent at 2016; and the greater than or equal to 50 category increases by 36.9% from 19.1 percent at 2005 to 26.2 percent at 2016.

Figure PA 5. Distribution of adults waiting for pancreas transplant by age
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Age is determined at the later of listing date or January 1 of the given year. Active and inactive candidates are included.


A line plot for distribution of adults waiting for pancreas transplant by race; the white category decreases by 18.5% from 75.7 percent at 2005 to 61.7 percent at 2016; the black category increases by 53.1% from 13.9 percent at 2005 to 21.2 percent at 2016; the hispanic category increases by 61.4% from 8.2 percent at 2005 to 13.3 percent at 2016; the asian category increases by 55.1% from 1.5 percent at 2005 to 2.3 percent at 2016; and the other/unknown category increases by 103.9% from 0.7 percent at 2005 to 1.4 percent at 2016.

Figure PA 6. Distribution of adults waiting for pancreas transplant by race
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included.


A line plot for distribution of adults waiting for pancreas transplant by diagnosis; the diabetes type 1 category is 84.6 percent at 2005 and remains relatively constant with a value of 82.4 percent at 2016; the diabetes type 2 category increases by 33.6% from 7.4 percent at 2005 to 9.9 percent at 2016; and the other category is 8 percent at 2005 and remains relatively constant with a value of 7.8 percent at 2016.

Figure PA 7. Distribution of adults waiting for pancreas transplant by diagnosis
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive candidates are included.


A line plot for distribution of adults waiting for pancreas transplant by waiting time; the less than 1 year category decreases by 11.6% from 47.3 percent at 2005 to 41.8 percent at 2016; the 1 to less than 2 category decreases by 10.1% from 22.6 percent at 2005 to 20.3 percent at 2016; the 2 to less than 3 category increases by 19.4% from 11.6 percent at 2005 to 13.9 percent at 2016; the 3 to less than 4 category is 7.6 percent at 2005 and remains relatively constant with a value of 7.8 percent at 2016; the 4 to less than 5 category is 5.3 percent at 2005 and remains relatively constant with a value of 5.2 percent at 2016; and the greater than or equal to 5 category increases by 96.0% from 5.6 percent at 2005 to 11 percent at 2016.

Figure PA 8. Distribution of adults waiting for pancreas transplant by waiting time
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Time on the waiting list is determined at the earlier of December 31 or removal from the waiting list. Active and inactive candidates are included.


A line plot for distribution of adults waiting for pancreas transplant by bmi; the less than 18.5 kg/m2 category decreases by 13.6% from 2.3 percent at 2005 to 2 percent at 2016; the 18.5 to less than 25 category decreases by 11.7% from 45.2 percent at 2005 to 39.9 percent at 2016; the 25 to less than 28 category is 24.3 percent at 2005 and remains relatively constant with a value of 25.2 percent at 2016; the 28 to less than 30 category increases by 40.1% from 9.9 percent at 2005 to 13.8 percent at 2016; the 30 to less than 35 category increases by 28.3% from 11.9 percent at 2005 to 15.2 percent at 2016; the 35 to less than 40 category increases by 22.1% from 2.4 percent at 2005 to 2.9 percent at 2016; and the greater than or equal to 40 category decreases by 29.8% from 0.9 percent at 2005 to 0.6 percent at 2016.

Figure PA 9. Distribution of adults waiting for pancreas transplant by BMI
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients are included.


A line plot for distribution of adults waiting for pancreas transplant by intended transplant type; the pak category decreases by 46.5% from 23.4 percent at 2005 to 12.5 percent at 2016; the pta category increases by 17.0% from 12.5 percent at 2005 to 14.6 percent at 2016; and the spk category increases by 13.6% from 64.2 percent at 2005 to 72.9 percent at 2016.

Figure PA 10. Distribution of adults waiting for pancreas transplant by intended transplant type
Candidates waiting for transplant at any time in the given year. Candidates listed concurrently at multiple centers are counted once. Active and inactive patients are included.


A line plot for deceased donor pancreas transplant rates among active adult waitlist candidates by diagnosis; the diabetes type 1 category increases by 20.8% from 65.5 transplants per 100 waitlist years at 2005 to 79.2 transplants per 100 waitlist years at 2016; the diabetes type 2 category increases by 154.1% from 46.5 transplants per 100 waitlist years at 2005 to 118.1 transplants per 100 waitlist years at 2016; and the other/unknown category is 82.1 transplants per 100 waitlist years at 2005 and remains relatively constant with a value of 86.7 transplants per 100 waitlist years at 2016.

Figure PA 11. Deceased donor pancreas transplant rates among active adult waitlist candidates by diagnosis
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deceased donor pancreas transplant rates among active adult waitlist candidates by intended transplant type; the pak category is 77.6 transplants per 100 waitlist years at 2005 and remains relatively constant with a value of 78.6 transplants per 100 waitlist years at 2016; the pta category is 90.8 transplants per 100 waitlist years at 2005 and remains relatively constant with a value of 93.1 transplants per 100 waitlist years at 2016; the spk category increases by 38.6% from 59 transplants per 100 waitlist years at 2005 to 81.8 transplants per 100 waitlist years at 2016; and the all category increases by 26.9% from 65.3 transplants per 100 waitlist years at 2005 to 82.9 transplants per 100 waitlist years at 2016.

Figure PA 12. Deceased donor pancreas transplant rates among active adult waitlist candidates by intended transplant type
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of active wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for three-year outcomes for adults waiting for pancreas after kidney transplant, new listings in 2013; the still waiting category decreases by 71.6% from 99.4 percent at 0 Months postlisting to 28.2 percent at 36 Months postlisting; the removed from list category increases by 4800.0% from 0.6 percent at 0 Months postlisting to 28.8 percent at 36 Months postlisting; the died category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; and the dd transplant category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting.

Figure PA 13. Three-year outcomes for adults waiting for pancreas after kidney transplant, new listings in 2013
Adults waiting for pancreas after kidney transplant and first listed in 2013. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor.


A line plot for three-year outcomes for adults waiting for pancreas transplant alone, new listings in 2013; the still waiting category decreases by 83.9% from 100 percent at 0 Months postlisting to 16.1 percent at 36 Months postlisting; the removed from list category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the died category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; and the dd transplant category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting.

Figure PA 14. Three-year outcomes for adults waiting for pancreas transplant alone, new listings in 2013
Adults waiting for pancreas transplant alone and first listed in 2013. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor.


A line plot for three-year outcomes for adults waiting for simultaneous kidney-pancreas transplant, new listings in 2013; the still waiting category decreases by 84.4% from 99.7 percent at 0 Months postlisting to 15.6 percent at 36 Months postlisting; the removed from list category increases by 7850.0% from 0.2 percent at 0 Months postlisting to 13.7 percent at 36 Months postlisting; the died category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the dd transplant category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; and the ld transplant category increases by 8000.0% from 0.1 percent at 0 Months postlisting to 7 percent at 36 Months postlisting.

Figure PA 15. Three-year outcomes for adults waiting for simultaneous kidney-pancreas transplant, new listings in 2013
Adults waiting for simultaneous kidney-pancreas transplant and first listed in 2013. Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. DD, deceased donor; LD, living donor.


A line plot for median months to pancreas transplant for waitlisted adults; the pak category increases by 143.4% from 24.7 months at 2005-2006 to 60.1 months at 2009-2010; the pta category increases by 60.6% from 11.3 months at 2005-2006 to 18.2 months at 2015-2016; and the spk category decreases by 22.7% from 21.5 months at 2005-2006 to 16.6 months at 2015-2016.

Figure PA 16. Median months to pancreas transplant for waitlisted adults
Observations censored on December 31, 2016; Kaplan-Meier competing risk methods used to estimate time to transplant. Analysis performed per candidate, not per listing. If an estimate is not plotted, 50% of the cohort listed in that year had not undergone transplant by the censoring date. Only the first transplant is counted.


A map of percentage of adults who underwent pancreas after kidney transplant within 2 years of listing in 2014 by dsa, the values range from 0.00 to 100.00.

Figure PA 17. Percentage of adults who underwent pancreas after kidney transplant within 2 years of listing in 2014 by DSA
Candidates listed concurrently in a single DSA are counted once in that DSA, from the time of earliest listing to the time of latest removal; candidates listed in multiple DSAs are counted separately per DSA. "No data" means no candidates were waiting in that DSA.


A map of percentage of adults who underwent pancreas transplant alone within 2 years of listing in 2014 by dsa, the values range from 0.00 to 100.00.

Figure PA 18. Percentage of adults who underwent pancreas transplant alone within 2 years of listing in 2014 by DSA
Candidates listed concurrently in a single DSA are counted once in that DSA, from the time of earliest listing to the time of latest removal; candidates listed in multiple DSAs are counted separately per DSA. "No data" means no candidates were waiting in that DSA.


A map of percentage of adults who underwent simultaneous kidney-pancreas transplant within 2 years of listing in 2014 by dsa, the values range from 19.75 to 100.00.

Figure PA 19. Percentage of adults who underwent simultaneous kidney-pancreas transplant within 2 years of listing in 2014 by DSA
Candidates listed concurrently in a single DSA are counted once in that DSA, from the time of earliest listing to the time of latest removal; candidates listed in multiple DSAs are counted separately per DSA. "No data" means no candidates were waiting in that DSA.


A line plot for pretransplant mortality rates among adults waitlisted for pancreas transplant by age; the 18 to 34 category decreases by 59.7% from 6.8 deaths per 100 waitlist years at 2005 to 2.8 deaths per 100 waitlist years at 2016; the 35 to 49 category decreases by 19.9% from 6.2 deaths per 100 waitlist years at 2005 to 5 deaths per 100 waitlist years at 2016; and the greater than or equal to 50 category decreases by 32.1% from 6.8 deaths per 100 waitlist years at 2005 to 4.6 deaths per 100 waitlist years at 2016.

Figure PA 20. Pretransplant mortality rates among adults waitlisted for pancreas transplant by age
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown. Age is determined at the later of listing date or January 1 of the given year.


A line plot for pretransplant mortality rates among adults waitlisted for pancreas transplant by race; the white category decreases by 32.0% from 6 deaths per 100 waitlist years at 2005 to 4.1 deaths per 100 waitlist years at 2016; the black category decreases by 26.6% from 8.8 deaths per 100 waitlist years at 2005 to 6.4 deaths per 100 waitlist years at 2016; and the other/unknown category decreases by 50.5% from 6.3 deaths per 100 waitlist years at 2005 to 3.1 deaths per 100 waitlist years at 2016.

Figure PA 21. Pretransplant mortality rates among adults waitlisted for pancreas transplant by race
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for pretransplant mortality rates among adults waitlisted for pancreas transplant by intended transplant type; the all category decreases by 31.3% from 6.4 deaths per 100 waitlist years at 2005 to 4.4 deaths per 100 waitlist years at 2016; the pak category decreases by 67.4% from 2.4 deaths per 100 waitlist years at 2005 to 0.8 deaths per 100 waitlist years at 2016; the pta category decreases by 42.0% from 3.1 deaths per 100 waitlist years at 2005 to 1.8 deaths per 100 waitlist years at 2016; and the spk category decreases by 35.1% from 8.8 deaths per 100 waitlist years at 2005 to 5.7 deaths per 100 waitlist years at 2016.

Figure PA 22. Pretransplant mortality rates among adults waitlisted for pancreas transplant by intended transplant type
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A map of pretransplant mortality rates among adults waitlisted for pancreas transplant in 2015-2016, by dsa, the values range from 0.00 to 15.27.

Figure PA 23. Pretransplant mortality rates among adults waitlisted for pancreas transplant in 2015-2016, by DSA
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the given year. Patients censored at waitlist removal. Individual listings are counted separately. Rates with less than 10 patient-years of exposure are not shown.


A line plot for deaths within six months after removal among adult pancreas waitlist candidates; the pak category decreases by 100.0% from 2.9 percent at 2005 to 0 percent at 2016; the pta category is 6 percent at 2005 and remains relatively constant with a value of 6.2 percent at 2016; the spk category decreases by 42.5% from 7.9 percent at 2005 to 4.5 percent at 2016; and the all category decreases by 30.9% from 5.9 percent at 2005 to 4.1 percent at 2016.

Figure PA 24. Deaths within six months after removal among adult pancreas waitlist candidates
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.


A line plot for deceased pancreas donors by age; the less than 18 category increases by 12.7% from 19.1 percent at 2005 to 21.6 percent at 2016; the 18 to 34 category increases by 27.2% from 51 percent at 2005 to 64.9 percent at 2016; the 35 to 49 category decreases by 47.0% from 24 percent at 2005 to 12.7 percent at 2016; the 50 to 64 category decreases by 88.0% from 5.6 percent at 2005 to 0.7 percent at 2016; and the greater than or equal to 65 category decreases by 24.1% from 0.2 percent at 2005 to 0.1 percent at 2016.

Figure PA 25. Deceased pancreas donors by age
Deceased donors whose pancreata were recovered for transplant (excluding islets).


A line plot for deceased pancreas donors by race; the white category is 69.4 percent at 2005 and remains relatively constant with a value of 64.3 percent at 2016; the black category increases by 29.7% from 15.2 percent at 2005 to 19.7 percent at 2016; the hispanic category is 12.9 percent at 2005 and remains relatively constant with a value of 12.1 percent at 2016; and the other/unknown category increases by 57.8% from 2.5 percent at 2005 to 4 percent at 2016.

Figure PA 26. Deceased pancreas donors by race
Deceased donors whose pancreata were recovered for transplant (excluding islets).


A map of deceased donor pancreas donation rates (per 1000 deaths) by state, 2013-2015, the values range from 0.00 to 3.09.

Figure PA 27. Deceased donor pancreas donation rates (per 1000 deaths) by state, 2013-2015
Deceased donors aged < 70 years, by state of death, whose pancreata was recovered for transplant from 2013 through 2015. Pancreata recovered for islet transplant are excluded. Denominator: US deaths aged < 70 years, by state of death, from 2013 through 2015. State death data by age obtained through agreement with NAPHSIS (https://www.naphsis.org/research-requests).


A line plot for rates of pancreata recovered for transplant and not transplanted by age; the less than 18 category is 14.9 percent at 2005 and remains relatively constant with a value of 15.6 percent at 2016; the 18 to 34 category is 21.2 percent at 2005 and remains relatively constant with a value of 23.1 percent at 2016; the 35 to 49 category decreases by 11.5% from 43.9 percent at 2005 to 38.8 percent at 2016; and the greater than or equal to 50 category is 78 percent at 2005 and remains relatively constant with a value of 81.8 percent at 2016.

Figure PA 28. Rates of pancreata recovered for transplant and not transplanted by age
Percentages of pancreata not transplanted out of all pancreata recovered for transplant. Pancreata recovered for islet transplant are excluded.


A line plot for rates of pancreata recovered for transplant and not transplanted by race; the white category decreases by 15.7% from 29.9 percent at 2005 to 25.2 percent at 2016; the black category decreases by 20.6% from 29.2 percent at 2005 to 23.2 percent at 2016; and the other/unknown category decreases by 13.8% from 23.3 percent at 2005 to 20.1 percent at 2016.

Figure PA 29. Rates of pancreata recovered for transplant and not transplanted by race
Percentages of pancreata not transplanted out of all pancreata recovered for transplant. Pancreata recovered for islet transplant are excluded.


A line plot for rates of pancreata recovered for transplant and not transplanted by bmi; the less than 18.5 kg/m2 category is 21.1 percent at 2005 and remains relatively constant with a value of 19.5 percent at 2016; the 18.5 to less than 25 category is 20.8 percent at 2005 and remains relatively constant with a value of 20.2 percent at 2016; the 25 to less than 30 category decreases by 20.4% from 33 percent at 2005 to 26.3 percent at 2016; the 30 to less than 35 category is 50 percent at 2005 and remains relatively constant with a value of 45.7 percent at 2016; and the greater than or equal to 35 category decreases by 13.6% from 66.2 percent at 2005 to 57.1 percent at 2016.

Figure PA 30. Rates of pancreata recovered for transplant and not transplanted by BMI
Percentages of pancreata not transplanted out of all pancreata recovered for transplant. Pancreata recovered for islet transplant are excluded.


A line plot for donor-specific components of the pancreas donor risk index; the age greater than 28 category decreases by 18.3% from 30.5 percent of donors at 2005 to 24.9 percent of donors at 2016; the black race category increases by 31.9% from 15.1 percent of donors at 2005 to 19.9 percent of donors at 2016; the asian race category increases by 133.0% from 1.5 percent of donors at 2005 to 3.5 percent of donors at 2016; the female category is 30.9 percent of donors at 2005 and remains relatively constant with a value of 32.7 percent of donors at 2016; the bmi greater than 25 kg/m2 category decreases by 10.5% from 36.3 percent of donors at 2005 to 32.5 percent of donors at 2016; the terminal scr greater than 2.5 mg/dl category increases by 16.0% from 1.9 percent of donors at 2005 to 2.2 percent of donors at 2016; the dcd category is 2.2 percent of donors at 2005 and remains relatively constant with a value of 2.2 percent of donors at 2016; and the cva death category decreases by 44.4% from 17.4 percent of donors at 2005 to 9.7 percent of donors at 2016.

Figure PA 31. Donor-specific components of the pancreas donor risk index
Donors whose pancreata was transplanted. The donor-specific components of the pancreas donor risk index are shown except for donor height. CVA, cerebrovascular accident; DCD, donation after circulatory death; SCr, serum creatinine.


A line plot for average pancreas donor risk index; the pak category decreases by 14.2% from 1.1 donor risk index at 2005 to 1 donor risk index at 2016; the pta category is 1.1 donor risk index at 2005 and remains relatively constant with a value of 1 donor risk index at 2016; and the spk category is 1.1 donor risk index at 2005 and remains relatively constant with a value of 1.1 donor risk index at 2016.

Figure PA 32. Average pancreas donor risk index
Pancreas donor risk index is computed using only donor-specific components.


A line plot for cause of death among deceased pancreas donors; the anoxia category increases by 198.2% from 10.9 percent at 2005 to 32.6 percent at 2016; the cva/stroke category decreases by 44.4% from 17.4 percent at 2005 to 9.7 percent at 2016; the head trauma category decreases by 22.5% from 69.7 percent at 2005 to 54 percent at 2016; the cns tumor category decreases by 20.9% from 0.6 percent at 2005 to 0.5 percent at 2016; and the other category increases by 134.9% from 1.4 percent at 2005 to 3.3 percent at 2016.

Figure PA 33. Cause of death among deceased pancreas donors
Donors whose pancreata was transplanted. CNS, central nervous system; CVA, cerebrovascular accident.


A line plot for total pancreas transplants; the pak category decreases by 78.4% from 343 transplants at 2005 to 74 transplants at 2016; the pta category decreases by 29.1% from 199 transplants at 2005 to 141 transplants at 2016; the spk category decreases by 11.6% from 903 transplants at 2005 to 798 transplants at 2016; and the all category decreases by 29.9% from 1445 transplants at 2005 to 1013 transplants at 2016.

Figure PA 34. Total pancreas transplants
All pancreas transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total pancreas transplants by age; the less than 18 category is 34 transplants at 2005 and remains relatively constant with a value of 37 transplants at 2016; the 18 to 34 category decreases by 30.1% from 332 transplants at 2005 to 232 transplants at 2016; the 35 to 49 category decreases by 40.4% from 846 transplants at 2005 to 504 transplants at 2016; and the greater than or equal to 50 category is 233 transplants at 2005 and remains relatively constant with a value of 240 transplants at 2016.

Figure PA 35. Total pancreas transplants by age
All pancreas transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total pancreas transplants by sex; the male category decreases by 28.5% from 834 transplants at 2005 to 596 transplants at 2016; and the female category decreases by 31.8% from 611 transplants at 2005 to 417 transplants at 2016.

Figure PA 36. Total pancreas transplants by sex
All pancreas transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total pancreas transplants by race; the white category decreases by 45.1% from 1120 transplants at 2005 to 615 transplants at 2016; the black category increases by 15.8% from 196 transplants at 2005 to 227 transplants at 2016; and the other/unknown category increases by 32.6% from 129 transplants at 2005 to 171 transplants at 2016.

Figure PA 37. Total pancreas transplants by race
All pancreas transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total pancreas transplants by diagnosis; the diabetes type 1 category decreases by 36.2% from 1234 transplants at 2005 to 787 transplants at 2016; the diabetes type 2 category increases by 69.4% from 62 transplants at 2005 to 105 transplants at 2016; and the other/unknown category decreases by 18.8% from 149 transplants at 2005 to 121 transplants at 2016.

Figure PA 38. Total pancreas transplants by diagnosis
All pancreas transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for total pancreas transplants by body mass index (bmi); the less than 18.5 kg/m2 category decreases by 29.2% from 72 transplants at 2005 to 51 transplants at 2016; the 18.5 to less than 25 category decreases by 41.9% from 750 transplants at 2005 to 436 transplants at 2016; the 25 to less than 28 category decreases by 13.5% from 304 transplants at 2005 to 263 transplants at 2016; the 28 to less than 30 category decreases by 10.8% from 139 transplants at 2005 to 124 transplants at 2016; the greater than or equal to 30 category is 153 transplants at 2005 and remains relatively constant with a value of 138 transplants at 2016; and the unknown category decreases by 96.3% from 27 transplants at 2005 to 1 transplants at 2016.

Figure PA 39. Total pancreas transplants by body mass index (BMI)
All pancreas transplant recipients, including adult and pediatric, retransplant, and multi-organ recipients.


A line plot for induction agent use in adult pancreas transplant recipients; the il2 to ra category decreases by 26.1% from 10.3 percent at 2005 to 7.6 percent at 2016; the t to cell depleting category increases by 21.0% from 70.1 percent at 2005 to 84.8 percent at 2016; and the none category decreases by 50.4% from 20.9 percent at 2005 to 10.3 percent at 2016.

Figure PA 40. Induction agent use in adult pancreas transplant recipients
Immunosuppression at transplant reported to the OPTN. IL2-RA, interleukin-2 receptor antagonist.


A line plot for calcineurin inhibitor use in adult pancreas transplant recipients; the cyclosporine category decreases by 70.6% from 5.7 percent at 2005 to 1.7 percent at 2016; and the tacrolimus category is 87.6 percent at 2005 and remains relatively constant with a value of 95.5 percent at 2016.

Figure PA 41. Calcineurin inhibitor use in adult pancreas transplant recipients
Immunosuppression at transplant reported to the OPTN.


A line plot for anti-metabolite use in adult pancreas transplant recipients; the azathioprine category increases by 41.7% from 0.4 percent at 2005 to 0.5 percent at 2016; and the mycophenolate category increases by 18.8% from 79.1 percent at 2005 to 94 percent at 2016.

Figure PA 42. Anti-metabolite use in adult pancreas transplant recipients
Immunosuppression at transplant reported to the OPTN. Mycophenolate includes mycophenolate mofetil and mycophenolate sodium.


A line plot for mtor inhibitor use in adult pancreas transplant recipients; the at transplant category decreases by 73.9% from 14.8 percent at 2005 to 3.9 percent at 2016; and the 1 year posttransplant category decreases by 55.2% from 20.5 percent at 2005 to 9.2 percent at 2015.

Figure PA 43. mTOR inhibitor use in adult pancreas transplant recipients
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant. mTOR, mammalian target of rapamycin.


A line plot for steroid use in adult pancreas transplant recipients; the at transplant category is 66.4 percent at 2005 and remains relatively constant with a value of 69.3 percent at 2016; and the 1 year posttransplant category is 68.4 percent at 2005 and remains relatively constant with a value of 72.5 percent at 2015.

Figure PA 44. Steroid use in adult pancreas transplant recipients
Immunosuppression at transplant reported to the OPTN. One-year posttransplant data are limited to patients alive with graft function at 1 year posttransplant.


A line plot for c/pra at time of transplant in adult recipients of pancreas after kidney transplant; the less than 1% category increases by 10.3% from 51.5 percent at 2005 to 56.8 percent at 2016; the 1 to less than 20% category decreases by 70.9% from 32.5 percent at 2005 to 9.5 percent at 2016; the 20 to less than 80% category increases by 104.2% from 12.6 percent at 2005 to 25.7 percent at 2016; the 80 to 100% category increases by 131.1% from 3.5 percent at 2005 to 8.1 percent at 2016; and the unknown category is 0 percent at 2005 and is percent at 2016.

Figure PA 45. C/PRA at time of transplant in adult recipients of pancreas after kidney transplant
From December 5, 2007, through September 30, 2009, CPRA was used if greater than 0; otherwise, the maximum pretransplant PRA was used. Before December 5, 2007, the maximum pretransplant PRA was used unconditionally. CPRA is used after September 30, 2009, unless it is missing; if it is missing, the maximum pretransplant PRA is used.


A line plot for c/pra at time of transplant in adult recipients of pancreas transplant alone; the less than 1% category is 58.1 percent at 2005 and remains relatively constant with a value of 61.1 percent at 2016; the 1 to less than 20% category decreases by 42.7% from 19.4 percent at 2005 to 11.1 percent at 2016; the 20 to less than 80% category increases by 47.5% from 13.2 percent at 2005 to 19.4 percent at 2016; the 80 to 100% category decreases by 10.4% from 9.3 percent at 2005 to 8.3 percent at 2016; and the unknown category is 0 percent at 2005 and is percent at 2016.

Figure PA 46. C/PRA at time of transplant in adult recipients of pancreas transplant alone
From December 5, 2007, through September 30, 2009, CPRA was used if greater than 0; otherwise, the maximum pretransplant PRA was used. Before December 5, 2007, the maximum pretransplant PRA was used unconditionally. CPRA is used after September 30, 2009, unless it is missing; if it is missing, the maximum pretransplant PRA is used.


A line plot for c/pra at time of transplant in adult recipients of simultaneous kidney-pancreas transplant; the less than 1% category increases by 12.7% from 63.3 percent at 2005 to 71.3 percent at 2016; the 1 to less than 20% category decreases by 51.9% from 21.3 percent at 2005 to 10.2 percent at 2016; the 20 to less than 80% category increases by 25.7% from 11.9 percent at 2005 to 14.9 percent at 2016; the 80 to 100% category is 3.6 percent at 2005 and remains relatively constant with a value of 3.5 percent at 2016; and the unknown category is 0 percent at 2005 and is percent at 2016.

Figure PA 47. C/PRA at time of transplant in adult recipients of simultaneous kidney-pancreas transplant
From December 5, 2007, through September 30, 2009, CPRA was used if greater than 0; otherwise, the maximum pretransplant PRA was used. Before December 5, 2007, the maximum pretransplant PRA was used unconditionally. CPRA is used after September 30, 2009, unless it is missing; if it is missing, the maximum pretransplant PRA is used.


A bar plot for total hla a, b, and dr mismatches among adult pancreas transplant recipients, 2012-2016, the 0 group is 0.64 percent; the 1 group is 1.50 percent; the 2 group is 5.58 percent; the 3 group is 13.52 percent; the 4 group is 25.32 percent; the 5 group is 36.27 percent; the 6 group is 17.17 percent; and the unk. group is 0.00 percent.

Figure PA 48. Total HLA A, B, and DR mismatches among adult pancreas transplant recipients, 2012-2016
Donor and recipient antigen matching is based on OPTN antigen values and split equivalences policy as of 2016.


A line plot for annual adult pancreas transplant center volumes, by percentile; the 5th category is 1 transplants per center at 2005 and remains relatively constant with a value of 1 transplants per center at 2016; the 25th category decreases by 50.0% from 4 transplants per center at 2005 to 2 transplants per center at 2016; the median category is 6 transplants per center at 2005 and remains relatively constant with a value of 6 transplants per center at 2016; the 75th category is 13 transplants per center at 2005 and remains relatively constant with a value of 12 transplants per center at 2016; and the 95th category decreases by 35.9% from 39 transplants per center at 2005 to 25 transplants per center at 2016.

Figure PA 49. Annual adult pancreas transplant center volumes, by percentile
Annual volume data are limited to recipients aged 18 or older.


A line plot for distribution of adult pancreas transplants by percentile of center volume; the less than or equal to 25th category decreases by 21.3% from 6.2 percent at 2005 to 4.9 percent at 2016; the greater than 25th to 75th category increases by 29.8% from 30.1 percent at 2005 to 39 percent at 2016; the greater than 75th to 95th category is 36 percent at 2005 and remains relatively constant with a value of 33.4 percent at 2016; and the greater than 95th category decreases by 18.2% from 27.7 percent at 2005 to 22.7 percent at 2016.

Figure PA 50. Distribution of adult pancreas transplants by percentile of center volume
Percentiles are based on annual volume data among recipients aged 18 or older.


A line plot for graft failure within the first 90 days posttransplant among adult pancreas transplant recipients; the pak category decreases by 42.3% from 14.3 percent at 2005-2006 to 8.3 percent at 2015-2016; the pta category decreases by 18.1% from 11.5 percent at 2005-2006 to 9.4 percent at 2015-2016; the spk to ki category decreases by 40.5% from 4.4 percent at 2005-2006 to 2.6 percent at 2015-2016; the spk to pa category decreases by 30.2% from 11.5 percent at 2005-2006 to 8 percent at 2015-2016; and the all category decreases by 32.2% from 12.9 percent at 2005-2006 to 8.7 percent at 2015-2016.

Figure PA 51. Graft failure within the first 90 days posttransplant among adult pancreas transplant recipients
All-cause graft failure is identified from multiple data sources, including the OPTN Transplant Recipient Registration Form, the OPTN Transplant Recipient Follow-up Form, and death dates from the Social Security Administration. Transplants after September 30, 2016, are excluded due to insufficient follow-up. Nonrenal multivisceral transplants are excluded.


A line plot for graft failure of the kidney among adult spk transplant recipients; the 1 to year category decreases by 79.6% from 15 percent at 1993 to 3.1 percent at 2015; the 5 to year category decreases by 47.2% from 31.3 percent at 1993 to 16.5 percent at 2011; and the 10 to year category decreases by 29.8% from 53.6 percent at 1993 to 37.7 percent at 2006.

Figure PA 52. Graft failure of the kidney among adult SPK transplant recipients
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. SPK transplant recipients are followed from date of transplant to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 1, 5, or 10 years posttransplant. All-cause graft failure (GF) is defined as any of the above outcomes prior to 1, 5, or 10 years, respectively. Nonrenal multivisceral transplants are excluded.


A line plot for death censored graft failure of the kidney among adult spk transplant recipients; the 1 to year category decreases by 86.7% from 10.5 percent at 1993 to 1.4 percent at 2015; the 5 to year category decreases by 49.4% from 20.4 percent at 1993 to 10.3 percent at 2011; and the 10 to year category decreases by 34.9% from 34.5 percent at 1993 to 22.5 percent at 2006.

Figure PA 53. Death censored graft failure of the kidney among adult SPK transplant recipients
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. SPK transplant recipients are followed from date of transplant to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 1, 5, or 10 years posttransplant. Death-censored graft failure (DCGF) is defined as return to dialysis, reported graft failure, or kidney retransplant. Nonrenal multivisceral transplants are excluded.


A line plot for kidney graft failure among adult pak transplant recipients with a deceased donor kidney (from time of pancreas transplant); the 1 to year category decreases by 79.7% from 16.5 percent at 1993-1995 to 3.3 percent at 2014-2015; the 5 to year category decreases by 50.8% from 43 percent at 1993-1995 to 21.2 percent at 2010-2011; and the 10 to year category decreases by 23.7% from 67.1 percent at 1993-1995 to 51.2 percent at 2004-2005.

Figure PA 54. Kidney graft failure among adult PAK transplant recipients with a deceased donor kidney (from time of pancreas transplant)
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. PAK transplant recipients who previously underwent deceased donor kidney transplant are followed from the date of pancreas transplant to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 1, 5, or 10 years posttransplant. Only PAK recipients with an OPTN record of previous kidney or kidney-pancreas transplant are included. Multivisceral transplants are excluded. All-cause graft failure (GF) is defined as any of the above outcomes prior to 1, 5, or 10 years, respectively.


A line plot for death-censored kidney graft failure among adult pak transplant recipients with a deceased donor kidney (from time of pancreas transplant); the 1 to year category decreases by 73.7% from 6.3 percent at 1993-1995 to 1.7 percent at 2014-2015; the 5 to year category decreases by 43.6% from 24.1 percent at 1993-1995 to 13.6 percent at 2010-2011; and the 10 to year category decreases by 34.2% from 34.2 percent at 1993-1995 to 22.5 percent at 2004-2005.

Figure PA 55. Death-censored kidney graft failure among adult PAK transplant recipients with a deceased donor kidney (from time of pancreas transplant)
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. PAK transplant recipients who previously underwent deceased donor kidney transplant are followed from the date of pancreas transplant to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death; or 1, 5, or 10 years posttransplant. Only PAK recipients with an OPTN record of previous kidney or kidney-pancreas transplant are included. Multivisceral transplants are excluded. Death-censored graft failure (DCGF) is defined as return to dialysis, reported graft failure, or kidney retransplant.


A line plot for kidney graft failure among adult pak transplant recipients with a living donor kidney (from time of pancreas transplant); the 1 to year category decreases by 51.9% from 6.2 percent at 1993-1995 to 3 percent at 2014-2015; the 5 to year category decreases by 38.4% from 22.2 percent at 1993-1995 to 13.7 percent at 2010-2011; and the 10 to year category decreases by 33.4% from 55.6 percent at 1993-1995 to 37 percent at 2004-2005.

Figure PA 56. Kidney graft failure among adult PAK transplant recipients with a living donor kidney (from time of pancreas transplant)
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. PAK transplant recipients who previously underwent living donor kidney transplant are followed from date of pancreas transplant to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death, or 1, 5, or 10 years posttransplant. Only PAK recipients with an OPTN record of a previous living kidney donor transplant are included. Multivisceral transplants are excluded. All-cause graft failure (GF) is defined as any of the above outcomes prior to 1, 5, or 10 years, respectively.


A line plot for death-censored kidney graft failure among adult pak transplant recipients with a living donor kidney (from time of pancreas transplant); the 1 to year category decreases by 100.0% from 1.2 percent at 1993-1995 to 0 percent at 2014-2015; the 5 to year category decreases by 21.9% from 11.1 percent at 1993-1995 to 8.7 percent at 2010-2011; and the 10 to year category decreases by 31.9% from 28.4 percent at 1993-1995 to 19.3 percent at 2004-2005.

Figure PA 57. Death-censored kidney graft failure among adult PAK transplant recipients with a living donor kidney (from time of pancreas transplant)
Estimates are unadjusted, computed using Kaplan-Meier competing risk methods. PAK transplant recipients who previously underwent living donor kidney transplant are followed from date of pancreas transplant to the earliest of kidney graft failure; kidney retransplant; return to dialysis; death, or 1, 5, or 10 years posttransplant. Only PAK recipients with an OPTN record of a previous living kidney donor transplant are included. Multivisceral transplants are excluded. Death-censored graft failure (DCGF) is defined as return to dialysis, reported graft failure, or kidney retransplant.


A line plot for recipients alive after pancreas transplant on june 30 of the year, by age at transplant; the less than 18 category decreases by 15.4% from 0 patients (in thousands) at 2005 to 0 patients (in thousands) at 2016; the 18 to 49 category increases by 32.0% from 11.6 patients (in thousands) at 2005 to 15.4 patients (in thousands) at 2016; the greater than or equal to 50 category increases by 102.8% from 1.4 patients (in thousands) at 2005 to 2.8 patients (in thousands) at 2016; and the all category increases by 39.5% from 13 patients (in thousands) at 2005 to 18.2 patients (in thousands) at 2016.

Figure PA 58. Recipients alive after pancreas transplant on June 30 of the year, by age at transplant
Recipients are not censored at reported graft failure since there is not a uniform definiton of graft failure nationally. However, a recipient may experience a reported graft failure and be removed from the cohort, undergo retransplant, and re-enter the cohort.


A bar plot for incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by transplant type, the pak transplant type is 16.86 percent for 2010-11, 14.54 percent for 2012 to 13, and 18.52 percent for 2014 to 15; the pta transplant type is 24.85 percent for 2010-11, 23.08 percent for 2012 to 13, and 15.48 percent for 2014 to 15; the spk transplant type is 15.01 percent for 2010-11, 15.20 percent for 2012 to 13, and 12.31 percent for 2014 to 15; and the all transplant type is 16.09 percent for 2010-11, 15.80 percent for 2012 to 13, and 13.17 percent for 2014 to 15.

Figure PA 59. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by transplant type
Acute rejection is defined as a record of acute or hyperacute rejection, as reported on the OPTN Transplant Recipient Registration or Transplant Recipient Follow-up Form. Only the first rejection event is counted. Cumulative incidence is estimated using the Kaplan-Meier competing risk method.


A line plot for incidence of ptld among adult recipients of pancreas after kidney transplant by recipient ebv status at transplant, 2004-2014; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv unknown category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant.

Figure PA 60. Incidence of PTLD among adult recipients of pancreas after kidney transplant by recipient EBV status at transplant, 2004-2014
Cumulative incidence is estimated using the Kaplan-Meier competing risk method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.


A line plot for incidence of ptld among adult recipients of pancreas transplant alone by recipient ebv status at transplant, 2004-2014; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv unknown category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant.

Figure PA 61. Incidence of PTLD among adult recipients of pancreas transplant alone by recipient EBV status at transplant, 2004-2014
Cumulative incidence is estimated using the Kaplan-Meier competing risk method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.


A line plot for incidence of ptld among adult recipients of simultaneous kidney-pancreas transplant by recipient ebv status at transplant, 2004-2014; the ebv to category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv+ category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; the ebv unknown category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant; and the all category is 0 percent at 0 Months posttransplant and is percent at 60 Months posttransplant.

Figure PA 62. Incidence of PTLD among adult recipients of simultaneous kidney-pancreas transplant by recipient EBV status at transplant, 2004-2014
Cumulative incidence is estimated using the Kaplan-Meier competing risk method. PTLD is identified as a reported complication or cause of death on the OPTN Transplant Recipient Follow-up Form or the Posttransplant Malignancy Form as polymorphic PTLD, monomorphic PTLD, or Hodgkin disease. Only the earliest date of PTLD diagnosis is considered. EBV, Epstein-Barr virus; PTLD, posttransplant lymphoproliferative disorder.


A line plot for patient death at one year among adult pancreas transplant recipients; the pak category decreases by 49.0% from 7.5 percent at 1993-1995 to 3.8 percent at 2014-2015; the pta category decreases by 93.0% from 10.9 percent at 1993-1995 to 0.8 percent at 2014-2015; and the spk category decreases by 67.6% from 7.3 percent at 1993-1995 to 2.4 percent at 2014-2015.

Figure PA 63. Patient death at one year among adult pancreas transplant recipients
Outcomes are computed using unadjusted Kaplan-Meier methods. Transplant recipients are followed from date of transplant to the earlier of death or 1 year posttransplant. Only first pancreas transplant is considered. PAK recipients without a record of previous kidney or kidney-pancreas transplant are reclassified as PTA.


A line plot for patient death at five years among adult pancreas transplant recipients; the pak category decreases by 59.0% from 19.4 percent at 1993-1995 to 7.9 percent at 2010-2011; the pta category decreases by 61.9% from 25.6 percent at 1993-1995 to 9.7 percent at 2010-2011; and the spk category decreases by 46.8% from 18.1 percent at 1993-1995 to 9.6 percent at 2010-2011.

Figure PA 64. Patient death at five years among adult pancreas transplant recipients
Outcomes are computed using unadjusted Kaplan-Meier methods. Transplant recipients are followed from date of transplant to the earlier of death or 5 years posttransplant. Only first pancreas transplant is considered. PAK recipients without a record of previous kidney or kidney-pancreas transplant are reclassified as PTA.


A line plot for patient death at ten years among adult pancreas transplant recipients; the pak category decreases by 35.8% from 46.3 percent at 1993-1995 to 29.7 percent at 2004-2005; the pta category decreases by 49.4% from 41.9 percent at 1993-1995 to 21.2 percent at 2004-2005; and the spk category decreases by 27.9% from 34.1 percent at 1993-1995 to 24.6 percent at 2004-2005.

Figure PA 65. Patient death at ten years among adult pancreas transplant recipients
Outcomes are computed using unadjusted Kaplan-Meier methods. Transplant recipients are followed from date of transplant to the earlier of death or 10 years posttransplant. Only first pancreas transplant is considered. PAK recipients without a record of previous kidney or kidney-pancreas transplant are reclassified as PTA.


A line plot for patient survival among adult deceased donor pancreas transplant recipients, 2011, by transplant type; the pak category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 91 percent at 60 Months post-transplant; the pta category decreases by 10.8% from 100 percent at 0 Months post-transplant to 89.2 percent at 60 Months post-transplant; the spk category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 90.4 percent at 60 Months post-transplant; and the all category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 90.4 percent at 60 Months post-transplant.

Figure PA 66. Patient survival among adult deceased donor pancreas transplant recipients, 2011, by transplant type
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


A line plot for patient survival among adult deceased donor pancreas transplant recipients, 2011, by primary diagnosis; the diabetes type 1 category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 90.5 percent at 60 Months post-transplant; the diabetes type 2 category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 91.5 percent at 60 Months post-transplant; and the other category decreases by 11.7% from 100 percent at 0 Months post-transplant to 88.3 percent at 60 Months post-transplant.

Figure PA 67. Patient survival among adult deceased donor pancreas transplant recipients, 2011, by primary diagnosis
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.


Table PA 1 Demographic characteristics of adults on the pancreas transplant waiting list on December 31, 2016
Candidates waiting for transplant on December 31, 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic PAK, N PAK, Pct PTA, N PTA, Pct SPK, N SPK, Pct
Age: 18-34 years 38 10.5% 92 24.7% 326 18.9%
Age: 35-49 years 184 50.7% 176 47.2% 946 54.8%
Age: 50-60 years 121 33.3% 86 23.1% 414 24.0%
Age: > 60 years 20 5.5% 19 5.1% 39 2.3%
Sex: Female 175 48.2% 202 54.2% 785 45.5%
Sex: Male 188 51.8% 171 45.8% 940 54.5%
Race/ethnicity: White 260 71.6% 294 78.8% 947 54.9%
Race/ethnicity: Black 47 12.9% 28 7.5% 450 26.1%
Race/ethnicity: Hispanic 45 12.4% 38 10.2% 252 14.6%
Race/ethnicity: Asian 8 2.2% 8 2.1% 48 2.8%
Race/ethnicity: Other/unknown 3 0.8% 5 1.3% 28 1.6%
BMI: < 18.5 kg/m2 4 1.1% 14 3.8% 26 1.5%
BMI: 18.5-< 25 kg/m2 148 40.8% 151 40.5% 693 40.2%
BMI: 25-< 28 kg/m2 91 25.1% 87 23.3% 439 25.4%
BMI: 28-< 30 kg/m2 51 14.0% 48 12.9% 245 14.2%
BMI: 30-< 35 kg/m2 52 14.3% 58 15.5% 247 14.3%
BMI: ≥ 35 kg/m2 13 3.6% 14 3.8% 73 4.2%
BMI: Unknown 4 1.1% 1 0.3% 2 0.1%
All candidates 363 100.0% 373 100.0% 1725 100.0%



Table PA 2 Clinical characteristics of adults on the pancreas transplant waiting list on December 31, 2016
Candidates waiting for transplant on December 31, 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic PAK, N PAK, Pct PTA, N PTA, Pct SPK, N SPK, Pct
Diagnosis: Diabetes type 1 321 88.4% 311 83.4% 1406 81.5%
Diagnosis: Diabetes type 2 30 8.3% 11 2.9% 202 11.7%
Diagnosis: Other 12 3.3% 51 13.7% 117 6.8%
Blood type: A 136 37.5% 132 35.4% 558 32.3%
Blood type: B 44 12.1% 39 10.5% 243 14.1%
Blood type: AB 14 3.9% 13 3.5% 48 2.8%
Blood type: O 169 46.6% 189 50.7% 876 50.8%
CPRA: < 1% 187 51.5% 216 57.9% 949 55.0%
CPRA: 1-< 20% 41 11.3% 23 6.2% 187 10.8%
CPRA: 20-< 80% 62 17.1% 59 15.8% 318 18.4%
CPRA: 80-< 98% 31 8.5% 30 8.0% 98 5.7%
CPRA: 98-100% 29 8.0% 43 11.5% 171 9.9%
CPRA: Unknown 13 3.6% 2 0.5% 2 0.1%
All candidates 363 100.0% 373 100.0% 1725 100.0%



Table PA 3 Listing characteristics of adults on the pancreas transplant waiting list on December 31, 2016
Candidates waiting for transplant on December 31, 2016, regardless of first listing date; multiple listings are collapsed.
Characteristic PAK, N PAK, Pct PTA, N PTA, Pct SPK, N SPK, Pct
Transplant history: First 251 69.1% 326 87.4% 1617 93.7%
Transplant history: Retransplant 112 30.9% 47 12.6% 108 6.3%
Wait time: < 1 year 95 26.2% 124 33.2% 697 40.4%
Wait time: 1-< 2 years 57 15.7% 69 18.5% 398 23.1%
Wait time: 2-< 3 years 46 12.7% 62 16.6% 261 15.1%
Wait time: 3-< 4 years 42 11.6% 28 7.5% 128 7.4%
Wait time: 4-< 5 years 30 8.3% 21 5.6% 91 5.3%
Wait time: ≥ 5 years 93 25.6% 69 18.5% 150 8.7%
All candidates 363 100.0% 373 100.0% 1725 100.0%



Table PA 4 Transplant waitlist activity among adults waiting for a pancreas after kidney transplant
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2014 2015 2016
Patients at start of year 538 474 398
Patients added during year 131 111 122
Patients removed during year 195 187 157
Patients at end of year 474 398 363



Table PA 5 Transplant waitlist activity among adults waiting for a pancreas transplant alone
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2014 2015 2016
Patients at start of year 424 427 416
Patients added during year 259 206 191
Patients removed during year 256 217 234
Patients at end of year 427 416 373



Table PA 6 Transplant waitlist activity among adults waiting for a simultaneous kidney pancreas transplant
Candidates concurrently listed at more than one center are counted once, from the time of earliest listing to the time of latest removal. Candidates who are listed, undergo transplant, and are relisted are counted more than once. Candidates are not considered to be on the list on the day they are removed; counts on January 1 may differ from counts on December 31 of the prior year. Candidates listed for multi-organ transplants are included.
Waiting list state 2014 2015 2016
Patients at start of year 1985 1991 1917
Patients added during year 1217 1162 1116
Patients removed during year 1211 1235 1308
Patients at end of year 1991 1918 1725



Table PA 7 Removal reason among adults waiting for pancreas after kidney transplant
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2014 2015 2016
Deceased donor transplant 64 58 55
Living donor kidney transplant 0 0 0
Patient died 15 10 3
Patient refused transplant 17 18 11
Improved, transplant not needed 2 2 3
Too sick for transplant 30 35 23
Changed to kidney-pancreas list 4 3 4
Other 63 61 58



Table PA 8 Removal reason among adults waiting for pancreas transplant alone
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2014 2015 2016
Deceased donor transplant 143 121 126
Living donor kidney transplant 0 0 0
Patient died 22 15 7
Patient refused transplant 14 13 9
Improved, transplant not needed 8 9 4
Too sick for transplant 13 15 16
Changed to kidney-pancreas list 7 11 4
Other 49 33 68



Table PA 9 Removal reason among adults waiting for simultaneous kidney-pancreas transplant
Removal reason as reported to the OPTN. Candidates with death dates that precede removal dates are assumed to have died waiting.
Removal reason 2014 2015 2016
Deceased donor transplant 723 739 818
Living donor kidney transplant 91 78 77
Patient died 136 132 107
Patient refused transplant 8 14 13
Improved, transplant not needed 5 13 12
Too sick for transplant 105 85 94
Changed to kidney-pancreas list 0 0 0
Other 143 174 187



Table PA 10 Demographic characteristics of adult pancreas transplant recipients, 2016
Adult pancreas transplant recipients, including retransplants.
Characteristic PAK, N PAK, Pct PTA, N PTA, Pct SPK, N SPK, Pct All, N All, Pct
Age: 18-34 years 16 21.6% 28 26.2% 188 23.6% 232 23.8%
Age: 35-49 years 39 52.7% 38 35.5% 427 53.7% 504 51.6%
Age: 50-60 years 18 24.3% 37 34.6% 166 20.9% 221 22.6%
Age: >60 years 1 1.4% 4 3.7% 14 1.8% 19 1.9%
Sex: Female 30 40.5% 58 54.2% 317 39.9% 405 41.5%
Sex: Male 44 59.5% 49 45.8% 478 60.1% 571 58.5%
Race/ethnicity: White 54 73.0% 96 89.7% 449 56.5% 599 61.4%
Race/ethnicity: Black 7 9.5% 2 1.9% 208 26.2% 217 22.2%
Race/ethnicity: Hispanic 11 14.9% 7 6.5% 109 13.7% 127 13.0%
Race/ethnicity: Asian 2 2.7% 1 0.9% 18 2.3% 21 2.2%
Race/ethnicity: Other/unknown 0 0.0% 1 0.9% 11 1.4% 12 1.2%
BMI: < 18.5 kg/m2 6 8.1% 4 3.7% 18 2.3% 28 2.9%
BMI: 18.5-< 25 kg/m2 32 43.2% 40 37.4% 356 44.8% 428 43.9%
BMI: 25-< 28 kg/m2 15 20.3% 29 27.1% 218 27.4% 262 26.8%
BMI: 28-< 30 kg/m2 7 9.5% 14 13.1% 103 13.0% 124 12.7%
BMI: 30-< 35 kg/m2 12 16.2% 19 17.8% 95 11.9% 126 12.9%
BMI: ≥ 35 kg/m2 2 2.7% 1 0.9% 5 0.6% 8 0.8%
Insurance: Private 31 41.9% 68 63.6% 318 40.0% 417 42.7%
Insurance: Medicare 37 50.0% 22 20.6% 423 53.2% 482 49.4%
Insurance: Other government 4 5.4% 15 14.0% 45 5.7% 64 6.6%
Insurance: Unknown 2 2.7% 2 1.9% 9 1.1% 13 1.3%
All recipients 74 100.0% 107 100.0% 795 100.0% 976 100.0%



Table PA 11 Clinical characteristics of adult pancreas transplant recipients, 2016
Adult pancreas transplant recipients, including retransplants.
Characteristic PAK, N PAK, Pct PTA, N PTA, Pct SPK, N SPK, Pct All, N All, Pct
Diagnosis: Diabetes type 1 70 94.6% 70 65.4% 647 81.4% 787 80.6%
Diagnosis: Diabetes type 2 4 5.4% 2 1.9% 99 12.5% 105 10.8%
Diagnosis: Other 0 0.0% 35 32.7% 49 6.2% 84 8.6%
Blood type: A 30 40.5% 54 50.5% 263 33.1% 347 35.6%
Blood type: B 9 12.2% 8 7.5% 105 13.2% 122 12.5%
Blood type: AB 4 5.4% 6 5.6% 32 4.0% 42 4.3%
Blood type: O 31 41.9% 39 36.4% 395 49.7% 465 47.6%
All recipients 74 100.0% 107 100.0% 795 100.0% 976 100.0%



Table PA 12 Transplant characteristics of adult pancreas transplant recipients, 2016
Adult pancreas transplant recipients, including retransplants.
Characteristic PAK, N PAK, Pct PTA, N PTA, Pct SPK, N SPK, Pct All, N All, Pct
Wait time: < 31 days 9 12.2% 17 15.9% 102 12.8% 128 13.1%
Wait time: 31-60 days 2 2.7% 14 13.1% 82 10.3% 98 10.0%
Wait time: 61-90 days 5 6.8% 14 13.1% 66 8.3% 85 8.7%
Wait time: 3-< 6 months 11 14.9% 25 23.4% 130 16.4% 166 17.0%
Wait time: 6-< 12 months 7 9.5% 17 15.9% 156 19.6% 180 18.4%
Wait time: 1-< 2 years 20 27.0% 13 12.1% 142 17.9% 175 17.9%
Wait time: 2-< 3 years 12 16.2% 2 1.9% 62 7.8% 76 7.8%
Wait time: ≥ 3 years 8 10.8% 5 4.7% 55 6.9% 68 7.0%
Tx type: Kidney-pancreas 0 0.0% 0 0.0% 791 99.5% 791 81.0%
Tx type: Pancreas only 74 100.0% 72 67.3% 0 0.0% 146 15.0%
Tx type: Other 0 0.0% 35 32.7% 4 0.5% 39 4.0%
Transplant history: First 47 63.5% 97 90.7% 782 98.4% 926 94.9%
Transplant history: Retransplant 27 36.5% 10 9.3% 13 1.6% 50 5.1%
All recipients 74 100.0% 107 100.0% 795 100.0% 976 100.0%



Table PA 13 Adult pancreas donor-recipient serology matching, 2012-2016
Donor serology is reported on the OPTN Donor Registration Form and recipient serology on the OPTN Transplant Recipient Registration Form. There may be multiple fields per serology. Any evidence for a positive serology is treated as positive for that serology. If all fields are unknown, incomplete, or pending, the person is categorized as unknown for that serology; otherwise, serology is assumed negative. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HB, hepatitis B; HCV, hepatitis C virus; HIV, human immunodeficiency virus.
Donor Recipient CMV EBV HB core HB surf. ant. HCV HIV
D- R- 12.3% 1.4% 88.1% 97.5% 97.2% 95.6%
D- R+ 13.1% 7.6% 3.4% 1.4% 1.6% 0.4%
D- R unk 15.3% 1.3% 7.9% 1.0% 1.1% 3.3%
D+ R- 16.7% 11.2% 0.5% 0.0% 0.0% 0.0%
D+ R+ 19.9% 71.0% 0.0% 0.0% 0.0% 0.0%
D+ R unk 22.2% 7.4% 0.0% 0.0% 0.0% 0.0%
D unk R- 0.2% 0.0% 0.0% 0.1% 0.0% 0.7%
D unk R+ 0.1% 0.1% 0.0% 0.0% 0.0% 0.0%
D unk R unk 0.2% 0.0% 0.0% 0.0% 0.0% 0.0%