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Pancreas

OPTN/SRTR 2017 Annual Data Report: Pancreas

Abstract

In 2017, 1492 patients were added to the pancreas transplant waiting list, 964 listed as active, a slight increase from 2016. This is significant because for the first time in the past decade, the steady downward trend in additions to the waiting list has been reversed. Proportions of pancreas donors with cerebrovascular accident as cause of death decreased, with a concomitant increase in proportions with anoxia and head trauma. This is partly a result of the national opioid crisis, and it reflects increasing use of younger donors for pancreas transplant. The 2017 outcome report remains compromised by previous variation in reporting graft failure. Although the OPTN Pancreas Transplantation Committee has approved more precise definitions of pancreas graft failure, implementation of these definitions took place recently, and the data are not reflected in this report.

Introduction

Below is a summary of recent activity of the OPTN/UNOS Pancreas Transplantation Committee:

  • A pancreas after kidney (PAK) guidance paper passed by the OPTN/UNOS Board in December 2017 provides guidance and data on how PAK may be an underused option that should be considered more frequently than it is. (See Fridell JA et al. The survival advantage of pancreas after kidney transplant. Am J Transplant. 2018; doi: 10.1111/ajt.15106. [Epub ahead of print]).
  • Simultaneous kidney-pancreas (SPK) waiting time policy was changed in a policy passed by the OPTN/UNOS Board in June 2018. Waiting time will no longer require that candidates with a C-peptide >2 have a body mass index (BMI) below the maximum. This change is set to be implemented in 2019.
  • A proposal updating islet bylaws was on consent at the regional meetings during fall 2018 public comment and was approved with amendments by the OPTN/UNOS Board in December 2018. The proposed changes to the islet Bylaws will better reflect the needs of islet programs and the expertise necessary to ensure patient safety.
  • A proposal changing pancreas program functional inactivity was generally supported during fall 2018 public comment and was approved by the OPTN/UNOS Board in December 2018. This project improves the pancreas program functional inactivity definition to provide more information to patients and avoid patients at low-volume transplant programs languishing on the waiting list.
  • The OPTN/UNOS Pancreas Committee is working with the OPTN/UNOS Kidney Committee to remove and replace donation service area and region as geographic units in kidney and pancreas allocation. This proposal will go out for public comment in spring 2019.

Waiting List

In 2017, 1492 patients were added to the pancreas transplant waiting list, 964 listed as active, a slight increase from 2016. This is significant because for the first time in the past decade, the steady downward trend in additions to the waiting list has been reversed. Increases were noted for SPK and pancreas transplant alone (PTA) listings, but there were continued decreases for PAK listings (Figure PA 1, Figure PA 2). Despite the number of additions to the waiting list outpacing the number of transplants, total prevalent candidates on the list continued a downward trend, perhaps accounted for by death on the waiting list or removal for other reasons (Figure PA 3, Figure PA 4). This trend was consistent across all transplant types.

The proportion of older candidates (aged ≥50 years) continued to increase slightly and comprised 26.6% of the waiting list in 2017 (Figure PA 5). This has been attributed to an increase in listings of candidates with type II diabetes, and the proportion of these candidates on the waiting list increased slightly to 11.7% in 2017 (9.8% in 2016) (Figure PA 8). This number is important because it falls within the 10%-15% range originally proposed by the OPTN/UNOS Pancreas Transplantation Committee as the acceptable proportion of candidates with type II diabetes on the waiting list while setting BMI limits for waiting time accrual for this group.

Gender distribution on the waiting list for 2017 was 55.4% male and 44.6% female (Figure PA 6), the first time in several years that the proportion of men increased. The proportion of white candidates continued a downward trend, at the lowest in over a decade (59.5%) in 2017, with a concomitant increase in black, Hispanic, and Asian candidates (Figure PA 7). BMI distribution among waitlisted candidates remained largely unchanged, with about 40% in the range of 18.5-25 kg/m2 in 2017 (Figure PA 10). SPK candidates accounted for 73.2% of the list, PTA candidates 14.8%, and PAK candidates 12.1% (Figure PA 11). As noted, proportions of PAK transplants continued decreasing while SPK and PTA increased gradually.

The proportion of prevalent candidates waiting <1 year for transplant increased to 45.4% in 2017 from 41.8% in 2016, presumably due to more new additions. However, the proportion waiting ≥1 year (1-2 and 2-3 years) decreased, suggesting that candidates were actively undergoing transplant during this time period (Figure PA 9).

Deceased donor transplant rates among candidates with type I diabetes continued to increase over the past 2 years and reached 39.4 transplants per 100 waitlist-years in 2017; for candidates with type II diabetes, the rate remained flat in 2017 (45.4), after an increase in 2016 (compared with 2015) (Figure PA 12). This may represent stabilization of transplant rates in candidates with type II diabetes after the new pancreas allocation system was implemented in late 2014. Transplant rates for SPK increased to 47.4 per 100 waitlist-years in 2017 from 42.6 in 2016, and rates for PTA remained flat. Interestingly, rates for PAK increased to 18.2 in 2017 from 14.3 in 2016, presumably from contraction of the waiting list considering that the number of PAK transplants declined (Figure PA 13).

Among candidates listed in 2014, 55.2% of SPK candidates, 50.6% of PTA candidates, and only 39.7% of PAK candidates underwent deceased donor transplant within 3 years (Figure PA 16, Figure PA 15, Figure PA 14), and 27%-34% of waiting pancreas candidates (PTA and PAK, respectively) were removed from the list without transplant or death during that period. Median months to transplant in 2016-2017 decreased to 12.9 for SPK and 22.8 for PTA, and could not be calculated for PAK because less than 50% of the cohort had undergone transplant, as has been the case since 2010 (Figure PA 17). No consistent pattern emerged in geographic distribution among the transplant types regarding percentage of candidates undergoing transplant within 2 years of listing, aside from a very high degree of disparity (Figure PA 18, Figure PA 19, Figure PA 20). A range of 0%-100% of candidates underwent transplant within each transplant type.

Overall pretransplant mortality rates decreased consistently over the years to 5.9 per 100 waitlist-years in 2017, compared with 7.5 in 2006 (Figure PA 23). As expected, mortality was highest for SPK candidates at 7.2 per 100 waitlist-years, compared with 5.40 for PAK and 3.1 for PTA. Waitlist mortality did not differ substantially by race (6.6 per 100 waitlist-years for black versus 6.2 for white candidates), although rates among the non-white/non-black race category have been consistently lower over the last 4 years (Figure PA 22). Of note, waitlist mortality declined in 2017 among candidates aged 35-49 years from 6.8 to 5.1 per 100 waitlist-years (Figure PA 21).

Pretransplant mortality rates by donation service area for the 2016-2017 cohort demonstrated geographic differences ranging from 0 to 22.2 per 100 waitlist-years (Figure PA 24). Death within 6 months after waitlist removal occurred for 5.8% of SPK, 4.3% of PAK, and 0% of PTA candidates (Figure PA 25). No deaths occurred among candidates aged >50 years (Figure PA 26).

Donations

No living donor pancreas transplants were reported in the United States in the past few years. Most deceased pancreas donors were aged <35 years, but the proportion of donors aged 35-64 years increased marginally in 2017 (Figure PA 27, Figure PA 28). No reported pancreas donors were aged ≥65 years. Most donors were white (63.8% in 2017); black and Hispanic donors account for 33.1% (Fig. 29).

The overall discard rate for pancreata recovered for transplant remained high and increased with donor age. Only 12.6% of pancreata were discarded from donors aged <18 years, compared with 72.7% from donors aged ≥50 years (Figure PA 30). Discard rates were unchanged for white donors at 24.6%, and declined for black donors from 23.2% in 2016 to 16.7% in 2017. Whether this is a function of the age demographic or other factors should be studied (Figure PA 31). Not surprisingly, the discard rate was directly correlated with donor BMI, and increased with increasing BMI (Figure PA 32). Over 80% of pancreata from donors with BMI ≥35 kg/m2 were discarded in 2017. Encouragingly, in the past 3 years, use of pancreata from Public Health Service increased-risk donors did not differ appreciably from use of other pancreata. Increased sensitivity of screening tests for transmissible infections contributed to this (Figure PA 33).

Average calculated pancreas donor risk index (PDRI) decreased steadily over the past decade. Overall PDRI was 1.04 in 2017, 0.98 for PAK, 1.11 for PTA, and 1.04 for SPK (Figure PA 35). Considering components of the PDRI, the proportion of donors with cerebrovascular accident (CVA) as cause of death declined remarkably to 7.9% in 2017. Use of donation after circulatory death donors remained low (<3%) (Figure PA 34). With the proportion of CVA decreasing as a cause of donor death came an expected increase in proportions of anoxia and head trauma. This is partly a result of the national opioid crisis, and it reflects increasing use of younger donors for pancreas transplant (Figure PA 36).

Transplants

The overall number of pancreas transplants remained stable, with 1002 transplants performed in 2017 (1013 in 2016). Of these, 213 were solitary pancreas transplants (PAK or PTA) (Figure PA 37). Enthusiasm for performing SPK transplants continued, especially for ages 35-49 years (Figure PA 38). The percentage of black transplant recipients has tended to increase over the past 5 years (Figure PA 40). Surprisingly, the proportion of type II diabetic recipients was unchanged from 2016, at about 10% of overall transplants (Figure PA 41). The concern that proportions of recipients with type II diabetes might increase substantially with relaxation of the upper limit of BMI from 28 to 30 has been somewhat allayed, at least for now.

Induction therapy in pancreas transplantation is predominantly based on T-cell depletion. The proportion of recipients receiving T-cell depleting agents has consistently increased over the past decade and is currently at its highest level; almost 87% of recipients received T-cell depletion therapy in 2017 (Figure PA 43). Of note, an uptick in steroid avoidance occurred in the context of Tac/MMF maintenance, with 40% of recipients receiving Tac/MMF with no steroids (Figure PA 44).

The proportion of unsensitized recipients ranged from approximately 60%-70%, depending on transplant type. No clear trends over time appeared, except for SPK, where the proportion of unsensitized recipients seemed to shrink over recent years (Figure PA 45, Figure PA 46, Figure PA 47). More PAK recipients were highly sensitized (c/PRA 80%-100%) than either SPK or PTA recipients. The overwhelming majority of pancreas transplant recipients (>75%) had >3 HLA mismatches. Despite some reports showing the immunologic value of -DR matching in SPK transplants and B locus matching in solitary pancreas transplants, there is little enthusiasm for overall HLA matching (Figure PA 48).

Regarding program volume, most pancreas transplants (about two-thirds) are performed at programs performing >10 pancreas transplants per year. In this group, the proportion of high-volume programs increased (>25 annually) over recent years. Not surprisingly, very low-volume programs (1-2 transplants per year) accounted for <5% of transplants (Figure PA 50).

Outcomes

The 2017 outcome report remains compromised by previous variation in reporting graft failure. Although the OPTN/UNOS Pancreas Transplantation Committee has approved more precise definitions of pancreas graft failure, implementation of these definitions took place in early 2018, and the data are not reflected in this report. Some of the definitions are concrete, such as: 1) a recipient’s transplanted pancreas is removed; 2) a recipient re-registers for pancreas transplant; 3) a recipient registers for an islet transplant after undergoing pancreas transplant; or 4) a recipient dies. Pancreas graft failure can also be defined if a recipient’s total insulin use is greater than or equal to 0.5 units/kg/day for a consecutive 90 days. The latter definition may be problematic if the recipient’s starting insulin dose is less than 0.5 units/kg/day. Nonetheless, these new definitions are a step in the right direction, and will provide an opportunity to analyze graft failure, based on a uniform definition, in subsequent SRTR reports. Although this report does not reflect the newer definitions, program-reported early pancreas graft failure has remained relative stable over the past 3 years, with rates of 9.2%, 7.3%, and 7.1 % for PAK, PTA, and SPK, respectively (Figure PA 51).

Unlike the variability in the data reported to OPTN/UNOS for pancreas graft outcomes, the data for kidney transplant graft outcomes following SPK and PAK are well defined. All-cause kidney graft failure following SPK was 4.9%, 16.6%, and 34.9% at 1, 5 and 10 years, respectively (Figure PA 52). These excellent results remained superior to results for non-SPK deceased donor kidney transplants, reflecting the higher quality of deceased donor kidneys used in SPK. All-cause kidney graft failure following deceased donor kidney PAK was 2.9%, 16.1%, and 47.1% at 1, 5, and 10 years, respectively (Figure PA 54). The slightly poorer long-term outcomes for PAK were likely related to kidney outcomes for PAK being based on time from pancreas transplant. The 10-year death-censored kidney graft failure rates for SPK and PAK were 21.4% (Figure PA 53) and 21.2% (Figure PA 55), respectively, and these high rates of graft survival demonstrated the high quality of kidneys (low KDPI) used in both SPK and PAK.

The data on patient survival following pancreas transplant (SPK, PAK, PTA) show nearly 18,500 pancreas recipients alive in 2017 (Figure PA 58). Patient mortality continued to decrease for all pancreas transplant categories, with 5-year mortality for PAK, PTA, and SPK at 8.1 %, 11.7%, and 8.8%, respectively (Figure 65). The long-term mortality data reflect the cardiovascular comorbidity in this population, with 10-year mortality of 28.9%, 20.7%, and 24.6% for PAK, PTA, and SPK, respectively (Figure PA 66). One-year mortality for PTA transplants in 2015-2016 was 0% (Figure PA 64), demonstrating improvements in patient selection, surgical technique, and immunosuppression management in these challenging recipients. Interestingly, 5-year patient survival following pancreas transplant was similar for transplants in recipients with type 1 (91%) and type 2 diabetes (93%) (Figure PA 68). Although patients with type 2 diabetes are usually older with more cardiovascular risk factors, similar mortality between the two groups speaks to good judgement in patient selection and preoperative assessment of cardiovascular risks. It will be important to gain a better understanding of the long-term metabolic benefits following pancreas transplant in recipients with type II diabetes.

Incidence of a first rejection episode remained consistently low for all categories of pancreas transplant for transplants performed in 2015-2016, and were 16.2%, 16.3%, and 13.7% following PAK, PTA, and SPK, respectively (Figure PA 59). These extremely low rejection rates clearly reflect ongoing improvements in immunosuppression protocols. Importantly, the cumulative incidence of posttransplant lymphoproliferative disorder is quite high in EBV-naive PTA recipients (6.1%), compared with 2.9% and 1.3% in EBV-naive SPK and PAK recipients, respectively (Figure PA 61, Figure PA 62, Figure PA 63). This is likely related to rigorous immunosuppressive regimens used to prevent rejection in the immunologically-challenging PTA recipients.

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 sex
Figure PA 7. Distribution of adults waiting for pancreas transplant by race
Figure PA 8. Distribution of adults waiting for pancreas transplant by diagnosis
Figure PA 9. Distribution of adults waiting for pancreas transplant by waiting time
Figure PA 10. Distribution of adults waiting for pancreas transplant by BMI
Figure PA 11. Distribution of adults waiting for pancreas transplant by intended transplant type
Figure PA 12. Deceased donor pancreas transplant rates among adult waitlist candidates by diagnosis
Figure PA 13. Deceased donor pancreas transplant rates among adult waitlist candidates by intended transplant type
Figure PA 14. Three-year outcomes for adults waiting for pancreas after kidney transplant, new listings in 2014
Figure PA 15. Three-year outcomes for adults waiting for pancreas transplant alone, new listings in 2014
Figure PA 16. Three-year outcomes for adults waiting for simultaneous kidney-pancreas transplant, new listings in 2014
Figure PA 17. Median months to pancreas transplant for waitlisted adults
Figure PA 18. Percentage of adults who underwent pancreas after kidney transplant within 2 years of listing in 2015 by DSA
Figure PA 19. Percentage of adults who underwent pancreas transplant alone within 2 years of listing in 2015 by DSA
Figure PA 20. Percentage of adults who underwent simultaneous kidney-pancreas transplant within 2 years of listing in 2015 by DSA
Figure PA 21. Pretransplant mortality rates among adults waitlisted for pancreas transplant by age
Figure PA 22. Pretransplant mortality rates among adults waitlisted for pancreas transplant by race
Figure PA 23. Pretransplant mortality rates among adults waitlisted for pancreas transplant by intended transplant type
Figure PA 24. Pretransplant mortality rates among adults waitlisted for pancreas transplant in 2016-2017, by DSA
Figure PA 25. Deaths within six months after removal among adult pancreas waitlist candidates, by intended transplant type
Figure PA 26. Deaths within six months after removal among adult pancreas waitlist candidates, by age at removal

Deceased donation

Figure PA 27. Deceased pancreas donor count by age
Figure PA 28. Distribution of deceased pancreas donors by age
Figure PA 29. Distribution of deceased pancreas donors by race
Figure PA 30. Rates of pancreata recovered for transplant and not transplanted by donor age
Figure PA 31. Rates of pancreata recovered for transplant and not transplanted by donor race
Figure PA 32. Rates of pancreata recovered for transplant and not transplanted by donor BMI
Figure PA 33. Rates of pancreass recovered for transplant and not transplanted, by donor risk of disease transmission
Figure PA 34. Donor-specific components of the pancreas donor risk index
Figure PA 35. Average pancreas donor risk index
Figure PA 36. Cause of death among deceased pancreas donors

Transplant

Figure PA 37. Total pancreas transplants
Figure PA 38. Total pancreas transplants by age
Figure PA 39. Total pancreas transplants by sex
Figure PA 40. Total pancreas transplants by race
Figure PA 41. Total pancreas transplants by diagnosis
Figure PA 42. Total pancreas transplants by body mass index (BMI)
Figure PA 43. Induction agent use in adult pancreas transplant recipients
Figure PA 44. Immunosuppression regimen 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, 2013-2017
Figure PA 49. Annual adult pancreas transplant center volumes, by percentile
Figure PA 50. Distribution of adult pancreas transplants by annual 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, 2015-2016
Figure PA 60. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by induction status, 2015-2016
Figure PA 61. Incidence of PTLD among adult recipients of pancreas after kidney transplant by recipient EBV status at transplant, 2005-2015
Figure PA 62. Incidence of PTLD among adult recipients of pancreas transplant alone by recipient EBV status at transplant, 2005-2015
Figure PA 63. Incidence of PTLD among adult recipients of simultaneous kidney-pancreas transplant by recipient EBV status at transplant, 2005-2015
Figure PA 64. Patient death at one year among adult pancreas transplant recipients
Figure PA 65. Patient death at five years among adult pancreas transplant recipients
Figure PA 66. Patient death at ten years among adult pancreas transplant recipients
Figure PA 67. Patient survival among adult deceased donor pancreas transplant recipients, 2010-2012, by transplant type
Figure PA 68. Patient survival among adult deceased donor pancreas transplant recipients, 2010-2012, by diagnosis
Figure PA 69. Patient survival among adult deceased donor pancreas transplant recipients, 2010-2012, by metropolitan vs. non-metropolitan recipient residence
Figure PA 70. Patient survival among adult deceased donor pancreas transplant recipients, 2010-2012, by recipients' distance from transplant center

Table List

Waiting list

Table PA 1. Demographic characteristics of adults on the pancreas transplant waiting list on December 31, 2017
Table PA 2. Clinical characteristics of adults on the pancreas transplant waiting list on December 31, 2017
Table PA 3. Listing characteristics of adults on the pancreas transplant waiting list on December 31, 2017
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, 2017
Table PA 11. Clinical characteristics of adult pancreas transplant recipients, 2017
Table PA 12. Transplant characteristics of adult pancreas transplant recipients, 2017
Table PA 13. Adult pancreas donor-recipient serology matching, 2013-2017

A line plot for new adult candidates added to the active pancreas transplant waiting list; the pak category decreases by 83.9% from 254 candidates at 2006 to 41 candidates at 2017; the pta category decreases by 47.2% from 212 candidates at 2006 to 112 candidates at 2017; the spk category decreases by 30.8% from 1172 candidates at 2006 to 811 candidates at 2017; and the all category decreases by 41.1% from 1638 candidates at 2006 to 964 candidates at 2017.

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 74.5% from 447 candidates at 2006 to 114 candidates at 2017; the pta category decreases by 27.7% from 292 candidates at 2006 to 211 candidates at 2017; the spk category decreases by 24.3% from 1541 candidates at 2006 to 1167 candidates at 2017; and the all category decreases by 34.6% from 2280 candidates at 2006 to 1492 candidates at 2017.

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 81.4% from 291 candidates at 2006 to 54 candidates at 2017; the pta category decreases by 37.5% from 184 candidates at 2006 to 115 candidates at 2017; the spk category decreases by 40.6% from 1442 candidates at 2006 to 856 candidates at 2017; and the all category decreases by 46.5% from 1917 candidates at 2006 to 1025 candidates at 2017.

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 66.7% from 986 candidates at 2006 to 328 candidates at 2017; the pta category decreases by 30.1% from 528 candidates at 2006 to 369 candidates at 2017; the spk category decreases by 28.0% from 2298 candidates at 2006 to 1655 candidates at 2017; and the all category decreases by 38.3% from 3812 candidates at 2006 to 2352 candidates at 2017.

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 19.6 percent at 2006 and remains relatively constant with a value of 21.4 percent at 2017; the 35 to 49 category decreases by 11.0% from 58.4 percent at 2006 to 52 percent at 2017; and the greater than or equal to 50 category increases by 21.1% from 22 percent at 2006 to 26.6 percent at 2017.

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 sex; the male category is 56.2 percent at 2006 and remains relatively constant with a value of 55.4 percent at 2017; and the female category is 43.8 percent at 2006 and remains relatively constant with a value of 44.6 percent at 2017.

Figure PA 6. Distribution of adults waiting for pancreas transplant by sex
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 race; the white category decreases by 21.1% from 75.4 percent at 2006 to 59.5 percent at 2017; the black category increases by 64.2% from 13.9 percent at 2006 to 22.8 percent at 2017; the hispanic category increases by 64.2% from 8.4 percent at 2006 to 13.9 percent at 2017; the asian category increases by 80.1% from 1.4 percent at 2006 to 2.5 percent at 2017; and the other/unknown category increases by 46.3% from 0.9 percent at 2006 to 1.3 percent at 2017.

Figure PA 7. 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 percent at 2006 and remains relatively constant with a value of 81 percent at 2017; the diabetes type 2 category increases by 53.9% from 7.6 percent at 2006 to 11.7 percent at 2017; and the other category decreases by 13.2% from 8.4 percent at 2006 to 7.3 percent at 2017.

Figure PA 8. 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 is 45.3 percent at 2006 and remains relatively constant with a value of 45.4 percent at 2017; the 1 to less than 2 category decreases by 16.9% from 22.8 percent at 2006 to 18.9 percent at 2017; the 2 to less than 3 category is 12.3 percent at 2006 and remains relatively constant with a value of 12.4 percent at 2017; the 3 to less than 4 category is 7.2 percent at 2006 and remains relatively constant with a value of 7.9 percent at 2017; the 4 to less than 5 category is 4.8 percent at 2006 and remains relatively constant with a value of 4.7 percent at 2017; and the greater than or equal to 5 category increases by 40.7% from 7.6 percent at 2006 to 10.7 percent at 2017.

Figure PA 9. 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 13.7% from 2.3 percent at 2006 to 2 percent at 2017; the 18.5 to less than 25 category decreases by 10.3% from 44.4 percent at 2006 to 39.8 percent at 2017; the 25 to less than 28 category is 24.1 percent at 2006 and remains relatively constant with a value of 25.8 percent at 2017; the 28 to less than 30 category increases by 49.0% from 9.8 percent at 2006 to 14.6 percent at 2017; the 30 to less than 35 category increases by 10.9% from 12.9 percent at 2006 to 14.3 percent at 2017; the 35 to less than 40 category is 2.7 percent at 2006 and remains relatively constant with a value of 2.8 percent at 2017; and the greater than or equal to 40 category decreases by 46.6% from 0.9 percent at 2006 to 0.5 percent at 2017.

Figure PA 10. 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 47.6% from 23 percent at 2006 to 12.1 percent at 2017; the pta category increases by 16.9% from 12.6 percent at 2006 to 14.8 percent at 2017; and the spk category increases by 13.7% from 64.3 percent at 2006 to 73.1 percent at 2017.

Figure PA 11. 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 adult waitlist candidates by diagnosis; the diabetes type 1 category increases by 11.5% from 35.3 transplants per 100 waitlist years at 2006 to 39.4 transplants per 100 waitlist years at 2017; the diabetes type 2 category increases by 49.8% from 30.3 transplants per 100 waitlist years at 2006 to 45.4 transplants per 100 waitlist years at 2017; and the other/unknown category is 56.9 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 52.3 transplants per 100 waitlist years at 2017.

Figure PA 12. Deceased donor pancreas transplant rates among adult waitlist candidates by diagnosis
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for deceased donor pancreas transplant rates among adult waitlist candidates by intended transplant type; the pak category decreases by 30.1% from 26.1 transplants per 100 waitlist years at 2006 to 18.2 transplants per 100 waitlist years at 2017; the pta category is 32.7 transplants per 100 waitlist years at 2006 and remains relatively constant with a value of 31.9 transplants per 100 waitlist years at 2017; the spk category increases by 14.6% from 41.4 transplants per 100 waitlist years at 2006 to 47.4 transplants per 100 waitlist years at 2017; and the all category increases by 12.3% from 36.4 transplants per 100 waitlist years at 2006 to 40.9 transplants per 100 waitlist years at 2017.

Figure PA 13. Deceased donor pancreas transplant rates among adult waitlist candidates by intended transplant type
Transplant rates are computed as the number of deceased donor transplants per 100 patient-years of wait time in a given year. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A line plot for three-year outcomes for adults waiting for pancreas after kidney transplant, new listings in 2014; the still waiting category decreases by 74.6% from 99.2 percent at 0 Months postlisting to 25.2 percent at 36 Months postlisting; the removed from list category increases by 4400.0% from 0.8 percent at 0 Months postlisting to 34.4 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 after kidney transplant, new listings in 2014
Adults waiting for pancreas after kidney transplant and first listed in 2014. 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 2014; the still waiting category decreases by 82.2% from 100 percent at 0 Months postlisting to 17.8 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 15. Three-year outcomes for adults waiting for pancreas transplant alone, new listings in 2014
Adults waiting for pancreas transplant alone and first listed in 2014. 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 2014; the still waiting category decreases by 83.8% from 99.9 percent at 0 Months postlisting to 16.2 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; 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 9300.0% from 0.1 percent at 0 Months postlisting to 7.7 percent at 36 Months postlisting.

Figure PA 16. Three-year outcomes for adults waiting for simultaneous kidney-pancreas transplant, new listings in 2014
Adults waiting for simultaneous kidney-pancreas transplant and first listed in 2014. 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 decreases by 13.4% from 43.8 months at 2006-2007 to 37.9 months at 2008-2009; the pta category increases by 110.6% from 10.8 months at 2006-2007 to 22.8 months at 2016-2017; and the spk category decreases by 39.4% from 21.3 months at 2006-2007 to 12.9 months at 2016-2017.

Figure PA 17. Median months to pancreas transplant for waitlisted adults
Observations censored on December 31, 2017; 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 2015 by dsa, the values range from 0.00 to 100.00.

Figure PA 18. Percentage of adults who underwent pancreas after kidney transplant within 2 years of listing in 2015 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 2015 by dsa, the values range from 0.00 to 100.00.

Figure PA 19. Percentage of adults who underwent pancreas transplant alone within 2 years of listing in 2015 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 2015 by dsa, the values range from 0.00 to 100.00.

Figure PA 20. Percentage of adults who underwent simultaneous kidney-pancreas transplant within 2 years of listing in 2015 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 39.7% from 7.4 deaths per 100 waitlist years at 2006 to 4.5 deaths per 100 waitlist years at 2017; the 35 to 49 category decreases by 31.8% from 7.5 deaths per 100 waitlist years at 2006 to 5.1 deaths per 100 waitlist years at 2017; and the greater than or equal to 50 category is 7.4 deaths per 100 waitlist years at 2006 and remains relatively constant with a value of 7 deaths per 100 waitlist years at 2017.

Figure PA 21. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk 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 12.7% from 7 deaths per 100 waitlist years at 2006 to 6.2 deaths per 100 waitlist years at 2017; the black category decreases by 37.8% from 10.6 deaths per 100 waitlist years at 2006 to 6.6 deaths per 100 waitlist years at 2017; and the other/unknown category decreases by 35.7% from 6.4 deaths per 100 waitlist years at 2006 to 4.1 deaths per 100 waitlist years at 2017.

Figure PA 22. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk 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 20.8% from 7.5 deaths per 100 waitlist years at 2006 to 5.9 deaths per 100 waitlist years at 2017; the pak category increases by 44.8% from 3.7 deaths per 100 waitlist years at 2006 to 5.4 deaths per 100 waitlist years at 2017; the pta category increases by 53.7% from 2 deaths per 100 waitlist years at 2006 to 3.1 deaths per 100 waitlist years at 2017; and the spk category decreases by 29.7% from 10.2 deaths per 100 waitlist years at 2006 to 7.2 deaths per 100 waitlist years at 2017.

Figure PA 23. 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. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. Individual listings are counted separately. Rates with less than 10 patient-years of exposure or fewer than 20 candidates at risk are not shown.


A map of pretransplant mortality rates among adults waitlisted for pancreas transplant in 2016-2017, by dsa, the values range from 0.00 to 22.17.

Figure PA 24. Pretransplant mortality rates among adults waitlisted for pancreas transplant in 2016-2017, by DSA
Mortality rates are computed as the number of deaths per 100 patient-years of waiting in the DSA. Waiting time is censored at transplant, death, transfer to another program, removal because of improved condition, or end of cohort. 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, by intended transplant type; the pak category decreases by 16.5% from 5.1 percent at 2006 to 4.3 percent at 2017; the pta category decreases by 100.0% from 1.3 percent at 2006 to 0 percent at 2017; the spk category decreases by 43.8% from 10.4 percent at 2006 to 5.8 percent at 2017; and the all category decreases by 40.4% from 7.4 percent at 2006 to 4.4 percent at 2017.

Figure PA 25. Deaths within six months after removal among adult pancreas waitlist candidates, by intended transplant type
Denominator includes only candidates removed from the waiting list for reasons other than transplant or death while on the list.


A line plot for deaths within six months after removal among adult pancreas waitlist candidates, by age at removal; the 18 to 34 category is 2.9 percent at 2006 and remains relatively constant with a value of 2.9 percent at 2017; the 35 to 49 category decreases by 11.3% from 9.1 percent at 2006 to 8.1 percent at 2017; and the 50+ category decreases by 100.0% from 6.7 percent at 2006 to 0 percent at 2017.

Figure PA 26. Deaths within six months after removal among adult pancreas waitlist candidates, by age at removal
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 donor count by age; the less than 18 category decreases by 30.4% from 388 count at 2006 to 270 count at 2017; the 18 to 34 category decreases by 15.4% from 1004 count at 2006 to 849 count at 2017; the 35 to 49 category decreases by 61.4% from 469 count at 2006 to 181 count at 2017; the 50 to 64 category decreases by 91.1% from 123 count at 2006 to 11 count at 2017; and the greater than or equal to 65 category decreases by 100.0% from 4 count at 2006 to 0 count at 2017.

Figure PA 27. Deceased pancreas donor count by age
Count of deceased donors whose pancreata were recovered for transplant (excluding islets), by age at donation.


A line plot for distribution of deceased pancreas donors by age; the less than 18 category is 21.9 percent at 2006 and remains relatively constant with a value of 23.6 percent at 2017; the 18 to 34 category increases by 14.6% from 57.3 percent at 2006 to 65.7 percent at 2017; the 35 to 49 category decreases by 46.2% from 19.3 percent at 2006 to 10.4 percent at 2017; the 50 to 64 category decreases by 79.1% from 1.4 percent at 2006 to 0.3 percent at 2017; and the greater than or equal to 65 category is 0 percent at 2006 and is percent at 2017.

Figure PA 28. Distribution of deceased pancreas donors by age
Deceased donors whose pancreata were recovered for transplant (excluding islets).


A line plot for distribution of deceased pancreas donors by race; the white category is 66.3 percent at 2006 and remains relatively constant with a value of 63 percent at 2017; the black category increases by 14.6% from 17.5 percent at 2006 to 20 percent at 2017; the hispanic category is 13.8 percent at 2006 and remains relatively constant with a value of 14.3 percent at 2017; and the other/unknown category increases by 10.5% from 2.4 percent at 2006 to 2.7 percent at 2017.

Figure PA 29. Distribution of deceased pancreas donors by race
Deceased donors whose pancreata were recovered for transplant (excluding islets).


A line plot for rates of pancreata recovered for transplant and not transplanted by donor age; the less than 18 category decreases by 41.1% from 21.4 percent at 2006 to 12.6 percent at 2017; the 18 to 34 category increases by 10.2% from 20.5 percent at 2006 to 22.6 percent at 2017; the 35 to 49 category is 42.8 percent at 2006 and remains relatively constant with a value of 42.5 percent at 2017; and the greater than or equal to 50 category decreases by 13.7% from 84.3 percent at 2006 to 72.7 percent at 2017.

Figure PA 30. Rates of pancreata recovered for transplant and not transplanted by donor 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 donor race; the white category decreases by 24.7% from 32.7 percent at 2006 to 24.6 percent at 2017; the black category decreases by 21.0% from 21.1 percent at 2006 to 16.7 percent at 2017; and the other/unknown category is 26.9 percent at 2006 and remains relatively constant with a value of 27.7 percent at 2017.

Figure PA 31. Rates of pancreata recovered for transplant and not transplanted by donor 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 donor bmi; the less than 18.5 kg/m2 category decreases by 22.4% from 25.8 percent at 2006 to 20 percent at 2017; the 18.5 to less than 25 category decreases by 12.2% from 21.4 percent at 2006 to 18.8 percent at 2017; the 25 to less than 30 category decreases by 20.1% from 33 percent at 2006 to 26.3 percent at 2017; the 30 to less than 35 category decreases by 17.8% from 54.1 percent at 2006 to 44.4 percent at 2017; and the greater than or equal to 35 category increases by 25.1% from 68.5 percent at 2006 to 85.7 percent at 2017.

Figure PA 32. Rates of pancreata recovered for transplant and not transplanted by donor BMI
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 pancreass recovered for transplant and not transplanted, by donor risk of disease transmission; the phs increased risk category is 23.6 percent at 2006 and remains relatively constant with a value of 24.5 percent at 2017; and the not increased risk category decreases by 23.3% from 30.6 percent at 2006 to 23.5 percent at 2017.

Figure PA 33. Rates of pancreass recovered for transplant and not transplanted, by donor risk of disease transmission
"Increased risk" is defined by criteria from the US Public Health Service Guidelines for increased risk for HIV, hepatitis B and hepatitis C transmission.


A line plot for donor-specific components of the pancreas donor risk index; the age greater than 28 category decreases by 20.5% from 31 percent of donors at 2006 to 24.6 percent of donors at 2017; the black race category increases by 14.6% from 17.5 percent of donors at 2006 to 20 percent of donors at 2017; the asian race category is 1.7 percent of donors at 2006 and remains relatively constant with a value of 1.8 percent of donors at 2017; the female category decreases by 11.0% from 31.9 percent of donors at 2006 to 28.4 percent of donors at 2017; the bmi greater than 25 kg/m2 category is 35.9 percent of donors at 2006 and remains relatively constant with a value of 35.4 percent of donors at 2017; the terminal scr greater than 2.5 mg/dl category increases by 26.5% from 1.6 percent of donors at 2006 to 2 percent of donors at 2017; the dcd category is 2.4 percent of donors at 2006 and remains relatively constant with a value of 2.6 percent of donors at 2017; and the cva death category decreases by 57.0% from 18.4 percent of donors at 2006 to 7.9 percent of donors at 2017.

Figure PA 34. 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 10.9% from 1.1 donor risk index at 2006 to 1 donor risk index at 2017; the pta category is 1.1 donor risk index at 2006 and remains relatively constant with a value of 1.1 donor risk index at 2017; and the spk category is 1.1 donor risk index at 2006 and remains relatively constant with a value of 1 donor risk index at 2017.

Figure PA 35. 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 179.2% from 11.8 percent at 2006 to 32.9 percent at 2017; the cva/stroke category decreases by 57.0% from 18.4 percent at 2006 to 7.9 percent at 2017; the head trauma category decreases by 15.6% from 67.5 percent at 2006 to 57 percent at 2017; the cns tumor category decreases by 72.2% from 0.4 percent at 2006 to 0.1 percent at 2017; and the other category is 1.9 percent at 2006 and remains relatively constant with a value of 2.1 percent at 2017.

Figure PA 36. 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 72.7% from 293 transplants at 2006 to 80 transplants at 2017; the pta category decreases by 23.1% from 173 transplants at 2006 to 133 transplants at 2017; the spk category decreases by 14.6% from 924 transplants at 2006 to 789 transplants at 2017; and the all category decreases by 27.9% from 1390 transplants at 2006 to 1002 transplants at 2017.

Figure PA 37. 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 decreases by 24.4% from 41 transplants at 2006 to 31 transplants at 2017; the 18 to 34 category decreases by 17.8% from 269 transplants at 2006 to 221 transplants at 2017; the 35 to 49 category decreases by 35.1% from 811 transplants at 2006 to 526 transplants at 2017; and the greater than or equal to 50 category decreases by 16.7% from 269 transplants at 2006 to 224 transplants at 2017.

Figure PA 38. 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 26.4% from 830 transplants at 2006 to 611 transplants at 2017; and the female category decreases by 30.2% from 560 transplants at 2006 to 391 transplants at 2017.

Figure PA 39. 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 46.6% from 1100 transplants at 2006 to 587 transplants at 2017; the black category increases by 40.2% from 174 transplants at 2006 to 244 transplants at 2017; and the other/unknown category increases by 47.4% from 116 transplants at 2006 to 171 transplants at 2017.

Figure PA 40. 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 30.9% from 1147 transplants at 2006 to 793 transplants at 2017; the diabetes type 2 category increases by 21.2% from 85 transplants at 2006 to 103 transplants at 2017; and the other/unknown category decreases by 32.9% from 158 transplants at 2006 to 106 transplants at 2017.

Figure PA 41. 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 54.1% from 61 transplants at 2006 to 28 transplants at 2017; the 18.5 to less than 25 category decreases by 33.3% from 681 transplants at 2006 to 454 transplants at 2017; the 25 to less than 28 category decreases by 16.1% from 322 transplants at 2006 to 270 transplants at 2017; the 28 to less than 30 category decreases by 14.4% from 146 transplants at 2006 to 125 transplants at 2017; the greater than or equal to 30 category decreases by 26.3% from 167 transplants at 2006 to 123 transplants at 2017; and the unknown category decreases by 84.6% from 13 transplants at 2006 to 2 transplants at 2017.

Figure PA 42. 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 21.1% from 8.8 percent at 2006 to 6.9 percent at 2017; the t to cell depleting category increases by 19.9% from 72.2 percent at 2006 to 86.6 percent at 2017; and the none category decreases by 51.9% from 20.5 percent at 2006 to 9.9 percent at 2017.

Figure PA 43. 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 immunosuppression regimen use in adult pancreas transplant recipients; the tac mmf steroid category increases by 13.9% from 50.2 percent at 2006 to 57.1 percent at 2017; the tac mmf category increases by 48.3% from 22.5 percent at 2006 to 33.3 percent at 2017; the tac steroid category decreases by 39.7% from 2.8 percent at 2006 to 1.7 percent at 2017; the other category decreases by 69.6% from 22.4 percent at 2006 to 6.8 percent at 2017; and the none reported category decreases by 52.2% from 2.1 percent at 2006 to 1 percent at 2017.

Figure PA 44. Immunosuppression regimen use in adult pancreas transplant recipients
Immunosuppression regimen at transplant reported to the OPTN. Tac, tacrolimus. MMF, mycophenolate mofetil.


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 23.3% from 49.7 percent at 2006 to 61.2 percent at 2017; the 1 to less than 20% category decreases by 75.1% from 30.1 percent at 2006 to 7.5 percent at 2017; the 20 to less than 80% category increases by 53.7% from 13 percent at 2006 to 20 percent at 2017; the 80 to 100% category increases by 56.4% from 7.2 percent at 2006 to 11.2 percent at 2017; and the unknown category is 0 percent at 2006 and is percent at 2017.

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 increases by 34.2% from 51 percent at 2006 to 68.5 percent at 2017; the 1 to less than 20% category decreases by 77.0% from 35.7 percent at 2006 to 8.2 percent at 2017; the 20 to less than 80% category increases by 87.9% from 10.2 percent at 2006 to 19.2 percent at 2017; the 80 to 100% category increases by 34.2% from 3.1 percent at 2006 to 4.1 percent at 2017; and the unknown category is 0 percent at 2006 and is percent at 2017.

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 is 62.1 percent at 2006 and remains relatively constant with a value of 67.7 percent at 2017; the 1 to less than 20% category decreases by 47.2% from 24.3 percent at 2006 to 12.8 percent at 2017; the 20 to less than 80% category increases by 74.2% from 9.2 percent at 2006 to 16 percent at 2017; the 80 to 100% category decreases by 21.6% from 4.4 percent at 2006 to 3.4 percent at 2017; and the unknown category is 0 percent at 2006 and is percent at 2017.

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, 2013-2017, the 0 group is 0.47 percent; the 1 group is 1.41 percent; the 2 group is 4.94 percent; the 3 group is 13.41 percent; the 4 group is 24.94 percent; the 5 group is 36.71 percent; the 6 group is 18.12 percent; and the unk. group is 0.00 percent.

Figure PA 48. Total HLA A, B, and DR mismatches among adult pancreas transplant recipients, 2013-2017
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 2006 and remains relatively constant with a value of 1 transplants per center at 2017; the 25th category is 3 transplants per center at 2006 and remains relatively constant with a value of 3 transplants per center at 2017; the median category is 6 transplants per center at 2006 and remains relatively constant with a value of 6 transplants per center at 2017; the 75th category decreases by 15.4% from 13 transplants per center at 2006 to 11 transplants per center at 2017; and the 95th category decreases by 22.6% from 31 transplants per center at 2006 to 24 transplants per center at 2017.

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 annual center volume; the 1 to 2 category increases by 28.8% from 3 percent of transplants at 2006 to 3.9 percent of transplants at 2017; the 3 to 10 category increases by 27.5% from 27.1 percent of transplants at 2006 to 34.5 percent of transplants at 2017; the 11 to 24 category increases by 31.0% from 31.2 percent of transplants at 2006 to 40.9 percent of transplants at 2017; and the greater than or equal to 25 category decreases by 46.5% from 38.7 percent of transplants at 2006 to 20.7 percent of transplants at 2017.

Figure PA 50. Distribution of adult pancreas transplants by annual center volume
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 30.9% from 13.2 percent at 2006-2007 to 9.2 percent at 2016-2017; the pta category decreases by 49.8% from 14.6 percent at 2006-2007 to 7.3 percent at 2016-2017; the spk to ki category decreases by 45.7% from 4.1 percent at 2006-2007 to 2.2 percent at 2016-2017; the spk to pa category decreases by 40.3% from 11.9 percent at 2006-2007 to 7.1 percent at 2016-2017; and the all category decreases by 40.4% from 13.2 percent at 2006-2007 to 7.9 percent at 2016-2017.

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, 2017, 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 36.0% from 7.7 percent at 2000 to 4.9 percent at 2016; the 5 to year category decreases by 30.7% from 23.9 percent at 2000 to 16.6 percent at 2012; and the 10 to year category decreases by 12.8% from 40.1 percent at 2000 to 34.9 percent at 2007.

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 23.5% from 3.6 percent at 2000 to 2.8 percent at 2016; the 5 to year category decreases by 25.2% from 14.4 percent at 2000 to 10.8 percent at 2012; and the 10 to year category is 23.6 percent at 2000 and remains relatively constant with a value of 21.4 percent at 2007.

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 58.2% from 7 percent at 1995-1997 to 2.9 percent at 2015-2016; the 5 to year category decreases by 58.0% from 38.3 percent at 1995-1997 to 16.1 percent at 2011-2012; and the 10 to year category decreases by 23.6% from 61.7 percent at 1995-1997 to 47.1 percent at 2005-2006.

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 37.3% from 2.3 percent at 1995-1997 to 1.5 percent at 2015-2016; the 5 to year category decreases by 65.0% from 16.4 percent at 1995-1997 to 5.7 percent at 2011-2012; and the 10 to year category decreases by 32.3% from 31.2 percent at 1995-1997 to 21.1 percent at 2005-2006.

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 74.4% from 4.5 percent at 1995-1997 to 1.2 percent at 2015-2016; the 5 to year category decreases by 57.7% from 27.3 percent at 1995-1997 to 11.5 percent at 2011-2012; and the 10 to year category decreases by 26.7% from 48.7 percent at 1995-1997 to 35.7 percent at 2005-2006.

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 0.6 percent at 1995-1997 to 0 percent at 2015-2016; the 5 to year category decreases by 49.2% from 13 percent at 1995-1997 to 6.6 percent at 2011-2012; and the 10 to year category decreases by 27.4% from 27.3 percent at 1995-1997 to 19.8 percent at 2005-2006.

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 is 0 patients (in thousands) at 2006 and remains relatively constant with a value of 0 patients (in thousands) at 2017; the 18 to 49 category increases by 26.2% from 12.3 patients (in thousands) at 2006 to 15.6 patients (in thousands) at 2017; the greater than or equal to 50 category increases by 85.6% from 1.6 patients (in thousands) at 2006 to 2.9 patients (in thousands) at 2017; and the all category increases by 32.8% from 13.9 patients (in thousands) at 2006 to 18.5 patients (in thousands) at 2017.

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 the uniform definiton of graft failure was not in effect until 2018. 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, 2015-2016, the pak group is 16.23 percent; the pta group is 16.31 percent; the spk group is 13.73 percent; and the all group is 14.14 percent.

Figure PA 59. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by transplant type, 2015-2016
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 bar plot for incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by induction status, 2015-2016, the il2-ra group is 11.28 percent; the tcd group is 14.15 percent; and the no agents group is 14.65 percent.

Figure PA 60. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by induction status, 2015-2016
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. If a recipient used both IL-2-RA and TCD agents, s/he will contribute to both of those cumulative incidence estimates.


A line plot for incidence of ptld among adult recipients of pancreas after kidney transplant by recipient ebv status at transplant, 2005-2015; 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 after kidney transplant by recipient EBV status at transplant, 2005-2015
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, 2005-2015; 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 pancreas transplant alone by recipient EBV status at transplant, 2005-2015
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, 2005-2015; 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 63. Incidence of PTLD among adult recipients of simultaneous kidney-pancreas transplant by recipient EBV status at transplant, 2005-2015
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 59.2% from 4.9 percent at 1995-1997 to 2 percent at 2015-2016; the pta category decreases by 100.0% from 5.5 percent at 1995-1997 to 0 percent at 2015-2016; and the spk category decreases by 56.7% from 5.7 percent at 1995-1997 to 2.5 percent at 2015-2016.

Figure PA 64. 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 64.0% from 22.4 percent at 1995-1997 to 8.1 percent at 2011-2012; the pta category decreases by 53.4% from 25.2 percent at 1995-1997 to 11.7 percent at 2011-2012; and the spk category decreases by 44.6% from 15.9 percent at 1995-1997 to 8.8 percent at 2011-2012.

Figure PA 65. 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 28.6% from 40.4 percent at 1995-1997 to 28.9 percent at 2005-2006; the pta category decreases by 47.3% from 39.3 percent at 1995-1997 to 20.7 percent at 2005-2006; and the spk category decreases by 20.8% from 31.1 percent at 1995-1997 to 24.6 percent at 2005-2006.

Figure PA 66. 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, 2010-2012, by transplant type; the pak category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 92.1 percent at 60 Months post-transplant; the pta category decreases by 11.7% from 100 percent at 0 Months post-transplant to 88.3 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 90.9 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 90.8 percent at 60 Months post-transplant.

Figure PA 67. Patient survival among adult deceased donor pancreas transplant recipients, 2010-2012, 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, 2010-2012, by 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 92.8 percent at 60 Months post-transplant; and the other category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 92.6 percent at 60 Months post-transplant.

Figure PA 68. Patient survival among adult deceased donor pancreas transplant recipients, 2010-2012, by diagnosis
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, 2010-2012, by metropolitan vs. non-metropolitan recipient residence; the metropolitan category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 90.7 percent at 60 Months post-transplant; and the non to metropolitan 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 69. Patient survival among adult deceased donor pancreas transplant recipients, 2010-2012, by metropolitan vs. non-metropolitan recipient residence
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, 2010-2012, by recipients

Figure PA 70. Patient survival among adult deceased donor pancreas transplant recipients, 2010-2012, by recipients' distance from transplant center
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered. Distance is between the zipcode centroids of the TX center and the recipient's permanent residence, measured in nautical miles (NM).


Table PA 1 Demographic characteristics of adults on the pancreas transplant waiting list on December 31, 2017
Candidates waiting for transplant on December 31, 2017, 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 45 13.7% 89 24.1% 329 19.9%
Age: 35-49 years 165 50.3% 175 47.4% 872 52.7%
Age: 50-60 years 101 30.8% 83 22.5% 403 24.4%
Age: > 60 years 17 5.2% 22 6.0% 51 3.1%
Sex: Female 156 47.6% 200 54.2% 733 44.3%
Sex: Male 172 52.4% 169 45.8% 922 55.7%
Race/ethnicity: White 226 68.9% 292 79.1% 867 52.4%
Race/ethnicity: Black 51 15.5% 25 6.8% 457 27.6%
Race/ethnicity: Hispanic 40 12.2% 38 10.3% 254 15.3%
Race/ethnicity: Asian 8 2.4% 8 2.2% 47 2.8%
Race/ethnicity: Other/unknown 3 0.9% 6 1.6% 30 1.8%
Geography: Metropolitan 278 84.8% 306 82.9% 1369 82.7%
Geography: Non-metro 50 15.2% 63 17.1% 286 17.3%
Distance: < 50 miles 204 62.2% 185 50.1% 1036 62.6%
Distance: 50-<100 miles 56 17.1% 54 14.6% 283 17.1%
Distance: 100-<150 miles 21 6.4% 39 10.6% 132 8.0%
Distance: 150-<250 miles 24 7.3% 21 5.7% 119 7.2%
Distance: ≥ 250 miles 21 6.4% 66 17.9% 78 4.7%
Distance: Unknown 2 0.6% 4 1.1% 7 0.4%
BMI: < 18.5 kg/m2 4 1.2% 14 3.8% 28 1.7%
BMI: 18.5-< 25 kg/m2 126 38.4% 165 44.7% 633 38.2%
BMI: 25-< 28 kg/m2 81 24.7% 85 23.0% 433 26.2%
BMI: 28-< 30 kg/m2 47 14.3% 37 10.0% 242 14.6%
BMI: 30-< 35 kg/m2 53 16.2% 56 15.2% 254 15.3%
BMI: ≥ 35 kg/m2 13 4.0% 11 3.0% 63 3.8%
BMI: Unknown 4 1.2% 1 0.3% 2 0.1%
All candidates 328 100.0% 369 100.0% 1655 100.0%



Table PA 2 Clinical characteristics of adults on the pancreas transplant waiting list on December 31, 2017
Candidates waiting for transplant on December 31, 2017, 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 1 292 89.0% 306 82.9% 1324 80.0%
Diagnosis: Diabetes type 2 28 8.5% 12 3.3% 233 14.1%
Diagnosis: Other 8 2.4% 51 13.8% 98 5.9%
Blood type: A 127 38.7% 156 42.3% 525 31.7%
Blood type: B 37 11.3% 37 10.0% 255 15.4%
Blood type: AB 16 4.9% 8 2.2% 49 3.0%
Blood type: O 148 45.1% 168 45.5% 826 49.9%
CPRA: < 1% 151 46.0% 218 59.1% 906 54.7%
CPRA: 1-< 20% 38 11.6% 23 6.2% 170 10.3%
CPRA: 20-< 80% 64 19.5% 53 14.4% 318 19.2%
CPRA: 80-< 98% 32 9.8% 30 8.1% 101 6.1%
CPRA: 98-100% 31 9.5% 44 11.9% 158 9.5%
CPRA: Unknown 12 3.7% 1 0.3% 2 0.1%
All candidates 328 100.0% 369 100.0% 1655 100.0%



Table PA 3 Listing characteristics of adults on the pancreas transplant waiting list on December 31, 2017
Candidates waiting for transplant on December 31, 2017, 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 221 67.4% 320 86.7% 1557 94.1%
Transplant history: Retransplant 107 32.6% 49 13.3% 98 5.9%
Wait time: < 1 year 91 27.7% 136 36.9% 740 44.7%
Wait time: 1-< 2 years 56 17.1% 71 19.2% 323 19.5%
Wait time: 2-< 3 years 34 10.4% 47 12.7% 222 13.4%
Wait time: 3-< 4 years 27 8.2% 35 9.5% 145 8.8%
Wait time: 4-< 5 years 31 9.5% 18 4.9% 79 4.8%
Wait time: ≥ 5 years 89 27.1% 62 16.8% 146 8.8%
All candidates 328 100.0% 369 100.0% 1655 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 2015 2016 2017
Patients at start of year 475 399 364
Patients added during year 111 122 114
Patients removed during year 187 157 150
Patients at end of year 399 364 328



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 2015 2016 2017
Patients at start of year 427 416 372
Patients added during year 206 191 211
Patients removed during year 217 234 214
Patients at end of year 416 373 369



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 2015 2016 2017
Patients at start of year 1992 1918 1724
Patients added during year 1162 1116 1167
Patients removed during year 1235 1308 1236
Patients at end of year 1919 1726 1655



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 2015 2016 2017
Deceased donor transplant 58 55 64
Living donor kidney transplant 0 0 0
Patient died 10 3 5
Patient refused transplant 18 11 17
Improved, transplant not needed 2 3 0
Too sick for transplant 35 23 15
Changed to kidney-pancreas list 3 4 0
Other 61 58 49



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 2015 2016 2017
Deceased donor transplant 121 126 117
Living donor kidney transplant 0 0 0
Patient died 15 7 12
Patient refused transplant 13 9 9
Improved, transplant not needed 9 4 6
Too sick for transplant 15 16 12
Changed to kidney-pancreas list 11 4 6
Other 33 68 52



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 2015 2016 2017
Deceased donor transplant 739 818 818
Living donor kidney transplant 78 77 64
Patient died 132 109 84
Patient refused transplant 14 13 9
Improved, transplant not needed 13 12 11
Too sick for transplant 85 93 89
Changed to kidney-pancreas list 0 0 0
Other 174 186 161



Table PA 10 Demographic characteristics of adult pancreas transplant recipients, 2017
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 10 12.5% 32 30.8% 179 22.7% 221 22.8%
Age: 35-49 years 48 60.0% 44 42.3% 434 55.1% 526 54.2%
Age: 50-60 years 19 23.8% 22 21.2% 148 18.8% 189 19.5%
Age: > 60 years 3 3.8% 6 5.8% 26 3.3% 35 3.6%
Sex: Female 33 41.2% 54 51.9% 290 36.8% 377 38.8%
Sex: Male 47 58.8% 50 48.1% 497 63.2% 594 61.2%
Race/ethnicity: White 61 76.2% 89 85.6% 418 53.1% 568 58.5%
Race/ethnicity: Black 11 13.8% 8 7.7% 219 27.8% 238 24.5%
Race/ethnicity: Hispanic 7 8.8% 4 3.8% 117 14.9% 128 13.2%
Race/ethnicity: Asian 1 1.2% 2 1.9% 24 3.0% 27 2.8%
Race/ethnicity: Other/unknown 0 0.0% 1 1.0% 9 1.1% 10 1.0%
BMI: < 18.5 kg/m2 0 0.0% 1 1.0% 16 2.0% 17 1.8%
BMI: 18.5-< 25 kg/m2 38 47.5% 39 37.5% 361 45.9% 438 45.1%
BMI: 25-< 28 kg/m2 23 28.8% 25 24.0% 221 28.1% 269 27.7%
BMI: 28-< 30 kg/m2 11 13.8% 15 14.4% 99 12.6% 125 12.9%
BMI: 30-< 35 kg/m2 8 10.0% 21 20.2% 88 11.2% 117 12.0%
BMI: ≥ 35 kg/m2 0 0.0% 3 2.9% 2 0.3% 5 0.5%
Insurance: Private 30 37.5% 69 66.3% 289 36.7% 388 40.0%
Insurance: Medicare 42 52.5% 24 23.1% 426 54.1% 492 50.7%
Insurance: Other government 8 10.0% 10 9.6% 72 9.1% 90 9.3%
Insurance: Unknown 0 0.0% 1 1.0% 0 0.0% 1 0.1%
Geography: Metropolitan 68 85.0% 79 76.0% 658 83.6% 805 82.9%
Geography: Non-metro 12 15.0% 25 24.0% 129 16.4% 166 17.1%
Distance: < 50 miles 54 67.5% 37 35.6% 459 58.3% 550 56.6%
Distance: 50-<100 miles 11 13.8% 21 20.2% 143 18.2% 175 18.0%
Distance: 100-<150 miles 9 11.2% 10 9.6% 85 10.8% 104 10.7%
Distance: 150-<250 miles 1 1.2% 15 14.4% 44 5.6% 60 6.2%
Distance: ≥ 250 miles 5 6.2% 20 19.2% 53 6.7% 78 8.0%
Distance: Unknown 0 0.0% 1 1.0% 3 0.4% 4 0.4%
All recipients 80 100.0% 104 100.0% 787 100.0% 971 100.0%



Table PA 11 Clinical characteristics of adult pancreas transplant recipients, 2017
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 75 93.8% 68 65.4% 648 82.3% 791 81.5%
Diagnosis: Diabetes type 2 4 5.0% 0 0.0% 99 12.6% 103 10.6%
Diagnosis: Other 1 1.2% 36 34.6% 40 5.1% 77 7.9%
Blood type: A 31 38.8% 34 32.7% 305 38.8% 370 38.1%
Blood type: B 9 11.2% 18 17.3% 79 10.0% 106 10.9%
Blood type: AB 2 2.5% 8 7.7% 28 3.6% 38 3.9%
Blood type: O 38 47.5% 44 42.3% 375 47.6% 457 47.1%
All recipients 80 100.0% 104 100.0% 787 100.0% 971 100.0%



Table PA 12 Transplant characteristics of adult pancreas transplant recipients, 2017
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 5 6.2% 24 23.1% 129 16.4% 158 16.3%
Wait time: 31-60 days 10 12.5% 16 15.4% 90 11.4% 116 11.9%
Wait time: 61-90 days 6 7.5% 7 6.7% 58 7.4% 71 7.3%
Wait time: 3-< 6 months 8 10.0% 19 18.3% 118 15.0% 145 14.9%
Wait time: 6-< 12 months 10 12.5% 19 18.3% 149 18.9% 178 18.3%
Wait time: 1-< 2 years 19 23.8% 5 4.8% 139 17.7% 163 16.8%
Wait time: 2-< 3 years 16 20.0% 6 5.8% 57 7.2% 79 8.1%
Wait time: ≥ 3 years 6 7.5% 8 7.7% 47 6.0% 61 6.3%
Tx type: Kidney-pancreas 0 0.0% 0 0.0% 786 99.9% 786 80.9%
Tx type: Pancreas only 80 100.0% 72 69.2% 0 0.0% 152 15.7%
Tx type: Other 0 0.0% 32 30.8% 1 0.1% 33 3.4%
Transplant history: First 54 67.5% 97 93.3% 777 98.7% 928 95.6%
Transplant history: Retransplant 26 32.5% 7 6.7% 10 1.3% 43 4.4%
All recipients 80 100.0% 104 100.0% 787 100.0% 971 100.0%



Table PA 13 Adult pancreas donor-recipient serology matching, 2013-2017
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- 19.0% 1.3% 89.9% 97.8% 97.5% 97.5%
D- R+ 21.8% 8.8% 3.3% 1.3% 1.7% 0.4%
D- R unk 0.3% 1.4% 6.2% 0.7% 0.7% 1.7%
D+ R- 26.1% 10.5% 0.5% 0.0% 0.1% 0.0%
D+ R+ 31.9% 73.3% 0.0% 0.0% 0.0% 0.0%
D+ R unk 0.2% 4.6% 0.0% 0.0% 0.0% 0.0%
D unk R- 0.3% 0.0% 0.0% 0.1% 0.0% 0.3%
D unk R+ 0.3% 0.1% 0.0% 0.0% 0.0% 0.0%