Pancreas

OPTN/SRTR 2018 Annual Data Report: Pancreas

Abstract

The overall number of pancreas transplants continued to increase to 1027 in 2018, after a nadir of 947 in 2015. New additions to waiting list remained stable, with 1485 candidates added in 2018. Proportions of patients with type II diabetes waiting for transplant (14.6%) and undergoing transplant (14.8%) have steadily increased since 2016. Waiting times for simultaneous pancreas/kidney transplant have decreased; median months to transplant was 13.5 for simultaneous pancreas/kidney transplant and 19.7 for pancreas transplant alone in 2018. Outcomes, including patient and kidney survival, as well as rejection rates, have improved consistently over the past several years. Pancreas graft survival data are being collected by the Organ Procurement and Transplantation Network and will be included in a future report once there are sufficient cohorts for analysis.

Introduction

Since the major revision to the pancreas allocation system (PAS) in 2014, pancreas transplant volume and outcomes have shown favorable trends. Largely driven by simultaneous pancreas/kidney transplant (SPK), pancreas transplants in patients with type II diabetes have increased, with good results.

The body mass index (BMI) limit of 30 kg/m² for patients with type II diabetes to qualify for the SPK waiting list was lifted in 2019, which could lead to a modest increase in transplants in these patients in the future. The Organ Procurement and Transplantation Network (OPTN) Pancreas Committee has been working on a broader distribution proposal that would remove donation service area (DSA) and regional boundaries as units of allocation and use instead a 500-nautical-mile circle around the donor hospital; at the time of this writing, the proposal is out for public comment. The Scientific Registry of Transplant Recipients (SRTR) was instrumental in developing and running kidney-pancreas simulated allocation modeling to help develop the proposal.

Despite increases in the total number of transplants, the decrease in solitary pancreas transplants, especially pancreas after kidney transplant (PAK), is cause for concern, and was addressed by the OPTN committee in a 2018 guidance paper. An unintended effect of early SPK access has been a decrease in living donor kidney transplants and PAKs. Due to the excellent long-term results of SPK transplants, this trend will likely continue. With the advent of closed loop insulin delivery systems and upcoming stem cell and islet technologies, pancreas transplant outcomes will have to continue to improve and morbidity (surgical and immunosuppressive) to be minimized to allow pancreas transplant to flourish as an attractive clinical option for patients with diabetes in the future.

Waiting List

Additions to the waiting list have remained relatively stable over the past 5 years: 1485 new patients were added in 2018, 962 as active listings. Additions to the SPK waiting list have remained relatively stable over the past 5 years, while new listings for solitary pancreas transplants (PAK and pancreas transplant alone [PTA]) have trended downward (Figure PA 1, Figure PA 2). Numbers of prevalent candidates on the waiting list have gradually decreased across all transplant types, as waitlist removals for transplant, death on the waiting list, or other reasons (Figure PA 3, Figure PA 4) outpace additions.

The 2018 age distribution was virtually unchanged from 2017; 52.2% of candidates were aged 35-49 years (Figure PA 5). The 2018 sex distribution showed a slight increase in the proportion of women (46%) compared with 2017, but was largely steady over the past 5 years (Figure PA 6). The percentage of white candidates has been steadily declining over the past decade (57.6% in 2018), while percentages of minority candidates (black, Hispanic, Asian, other) have increased correspondingly (Figure PA 7), possibly attributable to improved access to transplant and/or increased use of pancreas transplant for patients with type II diabetes. The proportion of patients with type II diabetes on the waiting list increased to 14.6% in 2018, and has been increasing since the new PAS was implemented in October 2014, paving a pathway for these patients to access SPK transplants. This proportion may increase in the future partly due to removal of the BMI limit for SPK listing for these patients (Figure PA 8). Consequently, proportions of higher-BMI patients have increased; in 2018, 15.0% had BMI 28-30 kg/m² and 15.5% had BMI 30-35 kg/m² (Figure PA 10). The proportion of prevalent candidates on the waiting list for less than 1 year increased to 46.3% in 2018 from 45.4% in 2017, presumably due to new additions and decreased waiting times. Interestingly, 10.3% of candidates had waited over 5 years in 2018, presumably due to sensitization and/or patient preference (especially for solitary pancreas transplants) (Figure PA 9).

The distribution of transplant types on the waiting list over the past 10 years shows a steady increase in SPK candidates with a corresponding decrease in PAK candidates and a slight increase in PTA candidates. SPK candidates account for 74.2% of the list in 2018, and this is likely to increase due to the recent allocation changes. PAKs accounted for 11.0% and PTAs for 14.8% (Fig PA 11).

The proportion of re-transplants has steadily decreased over the last few years (8.4% in 2018). This is in keeping with the decrease in solitary pancreas transplants, after which re-transplant occurs more commonly and earlier (Figure PA 12).

Deceased donor transplant rates increased in 2018 for patients with both type I and type II diabetes. The rate reached 41.1 transplants/100 waitlist-years for type I diabetes, and increased sharply to 56.6 transplants/100 waitlist-years for type II diabetes (Figure PA 13). With waitlist additions flat over the past several years, improving transplant rates is critical to avoid downward pressure on transplant volume. As expected, the increase in deceased donor transplants was driven by SPKs; the rate increased to 51.4/100 waitlist-years in 2018, up steadily from 35.4/100 waitlist-years in 2014. Rates for PAK (15.9/100 waitlist-years) and PTA (28.8/100 waitlist-years) declined in 2018 relative to 2017 (Figure PA 14).

Regarding 3-year outcomes for candidates listed in 2015, deceased donor transplants accounted for 44.1% of PAK, 54.9% of PTA, and 60.6% of SPK candidates. Of note, despite increasing transplant rates and decreasing waiting time for SPKs, waitlist mortality at 3 years post-listing was 6.3% in 2018. An additional 5.3% of SPK candidates underwent living donor kidney transplant, and some may have been moved to the PAK list (Figure PA 15, Figure PA 16, figure PA 17).

Median months to transplant declined consistently over the past 3 years for SPK (13.5 months in 2017-2018) and PTA (19.7 months). It was not calculated for PAK because less than 50% of the cohort had undergone transplant (Figure PA 18). The decrease in waiting times for SPK (approaching 1 year median) may have had the unintended effect of discouraging living donor kidney transplants in this group, which consequently decreased the number of PAKs. However, with early access to a combined transplant and excellent long-term outcomes for SPKs compared with PAKs, this may be a worthwhile tradeoff. No consistent pattern appeared in geographic distribution regarding percentages of candidates undergoing transplant within 2 years of listing, with disparities ranging from 0% to 100% across transplant types (Figure PA 19, Figure PA 20, Figure PA 21).

Overall pretransplant mortality rates in 2018 reversed the downward trend over the past decade and increased to 5.8 deaths/100 waitlist-years compared with 4.5 in 2017 and 6.9 in 2007. As expected, this was driven by SPKs, 7.6 deaths/100 waitlist-years in 2018, increased from 5.4 in 2017. Rates for PAK and PTA were 1.9 and 1.7, respectively (Figure PA 24).

Waitlist mortality increased across all age groups in 2018, most notably for ages 50 years or older, 7.1/100 waitlist-years, increased from 4.7 in 2017 (Figure PA 22). Waitlist mortality was higher among black compared with white candidates, 7.0 versus 5.7/100 waitlist-years, although rates for both groups increased in 2018 from 2017 (Figure PA 23).

Pretransplant mortality rates by DSA for the 2016-2017 cohort demonstrated substantial variability ranging from 0 to 20.0 deaths/100 waitlist-years, but the numbers were too small and too varied to allow meaningful conclusions (Figure PA 25). Death within 6 months after removal from the waiting list for reasons other than transplant occurred in 7.6% of all removed patients in 2018, increased from 4.9% in 2017, with 9.9% for SPK, 9.1% for PTA, and 0% for PAK (Figure PA 26). Post-removal deaths in patients older than 50 years increased sharply to 8.4% in 2018, from 2.3% in 2017 (Figure PA 27).

Donations

No living donor pancreas transplants have been reported in the United States in the last few years. Relatively short waiting times have led to the waning of this procedure. In parts of Asia, where deceased donors are not well established, living donor pancreas transplant remains prevalent.

A total of 1030 deceased pancreas donors in 2018 represent an increase from 1000 in 2017; 65.2% were aged 18-35 years, and with a general intolerance for older donors, only three (10.3%) were reported to be aged older than 50 years (Figure PA 28, Figure PA 29). Male to female ratios have remained about 2:1 over the past decade (Figure PA 30). Whites still account for most donors (60.8% in 2018), despite a slight decrease compared with 2017 (63%). Hispanic donors increased slightly to 15.1% in 2018 (Figure PA 31).

The overall discard rate for pancreata recovered for transplant was 21.3% in 2018, representing a steady decrease from 25.5% in 2015. About 40% of pancreata from donors with BMI over 30 kg/m² were discarded, compared with about 20% from donors with BMI below 30 (Figure PA 34). Discard rates increased with age, to 57.1% for donors aged older than 50 years; however, substantial progress over the past few years has resulted in fewer discards from older donors (Figure PA 32). Improved donor screening and selection for pancreas transplants presumably played a role. There were no noteworthy differences in discard rates by race (Figure PA 33) or PHS increased-risk status (Figure PA 35). Increased sensitivity of screening tests for transmissible infections and newer treatment options for viral infections (such as hepatitis C) have combined to eliminate PHS increased risk as a negative element in donor evaluation in most circumstances.

The average pancreas donor risk index (PDRI) has stabilized between 1.04 and 1.08 over the past 5 years. Notably, the PDRI for PTAs increased to 1.16 from 1.02 for the past 2 years (Figure PA 37). Trends over the next couple of years will be interesting to watch as broader distribution comes into play, and programs receive new types of offers more quickly. Regarding individual donor-specific components of the PDRI, larger proportions of donors were aged older than 28 years or had BMI over 25 kg/m² over the past 3 years. Use of donation after circulatory death donors remained stagnant at 2.4% in 2018 (Figure PA 36).

Anoxia as a cause of death continued an increasing trend over the past decade or more, presumably reflecting the prevalent opioid crisis and resultant tragedies. Head trauma and cerebrovascular accident have correspondingly decreased as causes of death (Figure PA 38).

Transplants

The overall number of pancreas transplants continued to increase to 1027 in 2018 after a nadir of 947 in 2015 and 1002 in 2017. The increase is attributed to SPK, and a downward trend continued in numbers of solitary transplants (PAK or PTA) (Figure PA 39). The number of recipients with type II diabetes undergoing pancreas transplant increased to 147 in 2018, up from 103 in 2017 (Figure PA 43). Similarly, the number of black recipients continued to increase over the past 5 years (Figure PA 42), mirroring the increase in the number of recipients with type II diabetes. There has been a slight increase in transplants to patients with BMI 28-30 kg/m² from a nadir in 2015, in keeping with the relaxation of the upper BMI limit from 28 to 30 for patients with type II diabetes (Figure PA 44).

Trends in induction and maintenance immunosuppression have not changed substantially over the past 5 years. Over 80% of pancreas transplant recipients receive induction with a T-cell depleting agent (Figure PA 45), reflecting previous higher rejection rates when lymphodepletion was avoided. Most recipients receive maintenance with tacrolimus/mycophenolate mofetil (TAC/MMF), with about 60% being maintained on steroids (Figure PA 46). A small increase continued in the number of recipients being maintained on steroid-free regimens in the context of TAC/MMF. The proportion of immunosuppressive agents in the “other” category remained low at 6.2%, suggesting that incorporation of TOR inhibitors into immunosuppressive regimens has not been widely adopted (Figure PA 46).

The proportion of unsensitized recipients has been stable, ranging from 54.4% for PAK, 68.0% for SPK, and 71.2% for PTA in 2018. This is consistent with the observation that a higher percentage of PAK recipients were highly sensitized (cPRA 80%-100%), reflecting prior exposure to HLA antigens (Figure PA 47, Figure PA 48, Figure PA 49). Almost all pancreas transplant recipients in all three categories had more than three HLA mismatches (Figure PA 50), consistent with the ongoing lack of enthusiasm for better matching. These data are also consistent with opinion of most pancreas transplant physicians/surgeons that the quality of the donor pancreas is more important than the HLA match in obtaining better outcomes.

Approximately two-thirds of pancreas transplants were performed at programs that perform more than 10 transplants per year, and these numbers have not changed substantially over the past decade. However, there has been a reduction since 2007 in the number of high-volume programs (≥25 transplants), and a growth in transplants performed at medium-volume programs (11-24 transplants). Low-volume programs (1-2 pancreas transplants/year) accounted for only 3.6% of all the pancreas transplants performed in 2018 (Figure PA 52).

Outcomes

The 2018 pancreas outcome report remains compromised by previous variations in reporting pancreas graft failure. Although patient survival and kidney allograft survival in SPK and PAK patients have been accurately reported, pancreas graft survival was defined by the reporting program. New, more concrete definitions for pancreas graft failure were implemented in early 2018. These include: 1) a recipient’s transplanted pancreas is removed; 2) a recipient re-registers for a pancreas transplant; 3) a recipient registers for an islet transplant after undergoing pancreas transplant; or 4) a recipients dies. Pancreas graft failure can also be defined if a recipient’s total insulin use is 0.5 units/kg/day or higher for a consecutive 90 days. The latter definition may be problematic if the recipient’s starting insulin dose was less than 0.5 units/kg/day. Nonetheless, the more uniform definitions will permit SRTR to provide more accurate data regarding pancreas allograft outcomes. The impact of the uniform definitions for pancreas allograft survival is not reflected in the 2018 report, since the new policy was implemented in early 2018. Regardless, 2018 data do not show an increase in early pancreas graft failure. In fact, the overall rate of early loss was 5.9%, down from 8.7% in 2017, and the lowest reported rate in the past decade (Figure PA 53).

Unlike variability in reporting pancreas allograft outcomes, the data for kidney allograft survival following SPK and PAK are based on uniform definitions applied by all reporting programs. All-cause kidney graft failure following SPK was 2.8%, 14.6%, and 36.3% at 1, 5, and 10 years, respectively (Figure PA 54).These excellent results are likely related to the higher quality of deceased donors required for SPK, and remain superior to results for non-SPK deceased donor kidney transplants. All-cause kidney graft failure following pancreas after deceased donor kidney transplant were 1.6%, 18.8%, and 42.4% at 1, 5, and 10 years, respectively (Figure PA 56), based on time from the pancreas transplant. All-cause kidney failure following pancreas after living donor kidney transplant were 3.1%, 16.8%, and 36.7% (Figure PA 58), reflecting the slightly better outcomes with a living donor. The 10-year death-censored kidney graft failure for SPK and living donor kidney PAK was 19.7% (Figure PA 55) and 19.0% (Figure PA 59), respectively, again reflecting the high quality of deceased donor kidneys (low kidney donor profile index) used in SPK and living donor kidneys in PAK.

Incidence of a first rejection episode 1 year after pancreas transplant remained consistently low for all pancreas transplant types in 2016-2017, 11.7%, 19.2 %, and 12.4% for PAK, PTA, and SPK respectively (Figure PA 61). The higher incidence of rejection after PTA may reflect a trend toward protocol biopsies based on historically higher incidence of rejection and lack of reliable markers for rejection in the absence of a simultaneously transplanted kidney. The cumulative incidence of posttransplant lymphoproliferative disorder remained high in Epstein-Barr virus (EBV)-naive PTA recipients (6.4%) compared with 2.7% and 1.7% in EBV-naive SPK and PAK recipients, respectively (Figure PA 63, Figure PA 64, and Figure PA 65). This is likely related to the more rigorous immunosuppressive regimens used to prevent rejection in PTA recipients, and is consistent with the higher rejection rates.

The number of pancreas transplant recipients alive in 2018 (excluding recipients of multivisceral organs) increased to 18,800 (Figure PA 60). Patient mortality at 1 year remained low for all pancreas transplant recipients, with rates of 3.0%, 1.5%, and 2.4% for PAK, PTA and SPK, respectively (Figure PA 66). Five-year mortality for SPK continued to decrease to 8.1%, the lowest reported rate (Figure PA 67). Long-term mortality of 26.8%, 20.1%, and 25.3% at 10 years for PAK, PTA, and SPK, respectively, represent the cardiovascular comorbidity in this population (Figure PA 68). Five-year patient survival for all pancreas transplants in 2011-2013 performed in recipients with type l diabetes was 91.1%, compared with 95.2% in recipients with type ll diabetes (Figure PA 70). The better outcomes for recipients with type ll diabetes may reflect more stringent criteria, particularly in light of the fact that these patients are usually older with more cardiovascular risk factors. It will be interesting to see if further liberalization of inclusion criteria (expanded BMI) initiated in 2018 will negatively affect outcomes for pancreas transplants performed in recipients with type ll diabetes.

Figure List

Waiting list

Deceased donation

Figure PA 28. Deceased pancreas donor count by age
Figure PA 29. Distribution of deceased pancreas donors by age
Figure PA 30. Distribution of deceased pancreas donors by sex
Figure PA 31. Distribution of deceased pancreas donors by race
Figure PA 32. Rates of pancreata recovered for transplant and not transplanted by donor age
Figure PA 33. Rates of pancreata recovered for transplant and not transplanted by donor race
Figure PA 34. Rates of pancreata recovered for transplant and not transplanted by donor BMI
Figure PA 35. Rates of pancreass recovered for transplant and not transplanted, by donor risk of disease transmission
Figure PA 36. Donor-specific components of the pancreas donor risk index
Figure PA 37. Average pancreas donor risk index of transplanted pancreata.
Figure PA 38. Cause of death among deceased pancreas donors

Transplant

Figure PA 39. Total pancreas transplants
Figure PA 40. Total pancreas transplants by age
Figure PA 41. Total pancreas transplants by sex
Figure PA 42. Total pancreas transplants by race
Figure PA 43. Total pancreas transplants by diagnosis
Figure PA 44. Total pancreas transplants by body mass index (BMI)
Figure PA 45. Induction agent use in adult pancreas transplant recipients
Figure PA 46. Immunosuppression regimen use in adult pancreas transplant recipients
Figure PA 47. C/PRA at time of transplant in adult recipients of pancreas after kidney transplant
Figure PA 48. C/PRA at time of transplant in adult recipients of pancreas transplant alone
Figure PA 49. C/PRA at time of transplant in adult recipients of simultaneous kidney-pancreas transplant
Figure PA 50. Total HLA A, B, and DR mismatches among adult pancreas transplant recipients, 2014-2018
Figure PA 51. Annual adult pancreas transplant center volumes, by percentile
Figure PA 52. Distribution of adult pancreas transplants by annual center volume

Outcomes

Table List

Waiting list

Table PA 1. Demographic characteristics of adults on the pancreas transplant waiting list on December 31, 2018
Table PA 2. Clinical characteristics of adults on the pancreas transplant waiting list on December 31, 2018
Table PA 3. Listing characteristics of adults on the pancreas transplant waiting list on December 31, 2018
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, 2018
Table PA 11. Clinical characteristics of adult pancreas transplant recipients, 2018
Table PA 12. Transplant characteristics of adult pancreas transplant recipients, 2018
Table PA 13. Adult pancreas donor-recipient serology matching, 2016-2018

A line plot for new adult candidates added to the pancreas transplant waiting list; the pak category decreases by 74.0% from 365 candidates at 2007 to 95 candidates at 2018; the pta category decreases by 28.8% from 278 candidates at 2007 to 198 candidates at 2018; the spk category decreases by 17.7% from 1448 candidates at 2007 to 1192 candidates at 2018; and the all category decreases by 29.0% from 2091 candidates at 2007 to 1485 candidates at 2018. — **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 82.8% from 238 candidates at 2007 to 41 candidates at 2018; the pta category decreases by 40.0% from 180 candidates at 2007 to 108 candidates at 2018; the spk category decreases by 37.9% from 1346 candidates at 2007 to 836 candidates at 2018; and the all category decreases by 44.2% from 1764 candidates at 2007 to 985 candidates at 2018. — **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 69.5% from 915 candidates at 2007 to 279 candidates at 2018; the pta category decreases by 28.2% from 511 candidates at 2007 to 367 candidates at 2018; the spk category decreases by 27.9% from 2207 candidates at 2007 to 1591 candidates at 2018; and the all category decreases by 38.4% from 3633 candidates at 2007 to 2237 candidates at 2018. — **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 increases by 13.3% from 19.2 percent at 2007 to 21.8 percent at 2018; the 35 to 49 category is 57.4 percent at 2007 and remains relatively constant with a value of 52.2 percent at 2018; and the greater than or equal to 50 category increases by 11.5% from 23.4 percent at 2007 to 26.1 percent at 2018. — **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 55.6 percent at 2007 and remains relatively constant with a value of 53.9 percent at 2018; and the female category is 44.4 percent at 2007 and remains relatively constant with a value of 46.1 percent at 2018. — **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 22.2% from 74.1 percent at 2007 to 57.6 percent at 2018; the black category increases by 71.0% from 14 percent at 2007 to 24 percent at 2018; the hispanic category increases by 48.9% from 9.4 percent at 2007 to 14 percent at 2018; the asian category increases by 76.6% from 1.6 percent at 2007 to 2.8 percent at 2018; and the other/unknown category increases by 77.6% from 0.9 percent at 2007 to 1.6 percent at 2018. — **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 84.1 percent at 2007 and remains relatively constant with a value of 78.4 percent at 2018; the diabetes type 2 category increases by 99.5% from 7.3 percent at 2007 to 14.6 percent at 2018; and the other category decreases by 19.4% from 8.6 percent at 2007 to 7 percent at 2018. — **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 43.3 percent at 2007 and remains relatively constant with a value of 46.3 percent at 2018; the 1 to less than 2 category is 22.3 percent at 2007 and remains relatively constant with a value of 20.6 percent at 2018; the 2 to less than 3 category decreases by 17.1% from 12.8 percent at 2007 to 10.6 percent at 2018; the 3 to less than 4 category is 7.7 percent at 2007 and remains relatively constant with a value of 7.2 percent at 2018; the 4 to less than 5 category is 4.6 percent at 2007 and remains relatively constant with a value of 5 percent at 2018; and the greater than or equal to 5 category increases by 10.5% from 9.3 percent at 2007 to 10.3 percent at 2018. — **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 23.6% from 2.4 percent at 2007 to 1.9 percent at 2018; the 18.5 to less than 25 category decreases by 10.7% from 43 percent at 2007 to 38.4 percent at 2018; the 25 to less than 28 category is 24.7 percent at 2007 and remains relatively constant with a value of 25.7 percent at 2018; the 28 to less than 30 category increases by 45.3% from 10.3 percent at 2007 to 15 percent at 2018; the 30 to less than 35 category increases by 17.0% from 13.3 percent at 2007 to 15.5 percent at 2018; and the greater than or equal to 35 category decreases by 12.1% from 3.8 percent at 2007 to 3.4 percent at 2018. — **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 51.8% from 22.9 percent at 2007 to 11 percent at 2018; the pta category is 13.6 percent at 2007 and remains relatively constant with a value of 14.8 percent at 2018; and the spk category increases by 16.8% from 63.5 percent at 2007 to 74.2 percent at 2018. — **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 distribution of adults waiting for pancreas transplant by prior pancreas transplant status; the yes category decreases by 21.3% from 10.7 percent at 2007 to 8.4 percent at 2018; and the no category is 89.3 percent at 2007 and remains relatively constant with a value of 91.6 percent at 2018. — **Figure PA 12. Distribution of adults waiting for pancreas transplant by prior pancreas transplant status**
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 19.1% from 34.5 transplants per 100 waitlist years at 2007 to 41.1 transplants per 100 waitlist years at 2018; the diabetes type 2 category increases by 138.3% from 23.7 transplants per 100 waitlist years at 2007 to 56.6 transplants per 100 waitlist years at 2018; and the other/unknown category decreases by 19.4% from 53.9 transplants per 100 waitlist years at 2007 to 43.4 transplants per 100 waitlist years at 2018. — **Figure PA 13. 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 32.7% from 23.6 transplants per 100 waitlist years at 2007 to 15.9 transplants per 100 waitlist years at 2018; the pta category decreases by 18.2% from 35.2 transplants per 100 waitlist years at 2007 to 28.8 transplants per 100 waitlist years at 2018; the spk category increases by 29.3% from 39.7 transplants per 100 waitlist years at 2007 to 51.4 transplants per 100 waitlist years at 2018; and the all category increases by 23.1% from 35.1 transplants per 100 waitlist years at 2007 to 43.2 transplants per 100 waitlist years at 2018. — **Figure PA 14. 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 2015; the still waiting category decreases by 75.7% from 100 percent at 0 Months postlisting to 24.3 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 after kidney transplant, new listings in 2015**
Adults waiting for pancreas after kidney transplant and first listed in 2015. 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 2015; the still waiting category decreases by 80.5% from 99.5 percent at 0 Months postlisting to 19.4 percent at 36 Months postlisting; the removed from list category increases by 4500.0% from 0.5 percent at 0 Months postlisting to 22.3 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 16. Three-year outcomes for adults waiting for pancreas transplant alone, new listings in 2015**
Adults waiting for pancreas transplant alone and first listed in 2015. 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 2015; the still waiting category decreases by 84.9% from 99.7 percent at 0 Months postlisting to 15.1 percent at 36 Months postlisting; the removed from list category is 0 percent at 0 Months postlisting and is percent at 36 Months postlisting; the died category increases by 7200.0% from 0.1 percent at 0 Months postlisting to 6.3 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 2950.0% from 0.2 percent at 0 Months postlisting to 5.2 percent at 36 Months postlisting. — **Figure PA 17. Three-year outcomes for adults waiting for simultaneous kidney-pancreas transplant, new listings in 2015**
Adults waiting for simultaneous kidney-pancreas transplant and first listed in 2015. 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 pta category increases by 87.5% from 10.5 months at 2007-2008 to 19.7 months at 2015-2016; and the spk category decreases by 43.0% from 23.7 months at 2007-2008 to 13.5 months at 2017-2018. — **Figure PA 18. Median months to pancreas transplant for waitlisted adults**
Observations censored on December 31, 2018; 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. Median wait time for PAK transplants was not observed after 2010.

A map of percentage of adults who underwent pancreas after kidney transplant within 2 years of listing in 2016 by dsa, the values range from 0.00 to 100.00. — **Figure PA 19. Percentage of adults who underwent pancreas after kidney transplant within 2 years of listing in 2016 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 2016 by dsa, the values range from 0.00 to 100.00. — **Figure PA 20. Percentage of adults who underwent pancreas transplant alone within 2 years of listing in 2016 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 2016 by dsa, the values range from 0.00 to 100.00. — **Figure PA 21. Percentage of adults who underwent simultaneous kidney-pancreas transplant within 2 years of listing in 2016 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 15.7% from 6.7 deaths per 100 waitlist years at 2007 to 5.6 deaths per 100 waitlist years at 2018; the 35 to 49 category decreases by 14.7% from 6.2 deaths per 100 waitlist years at 2007 to 5.3 deaths per 100 waitlist years at 2018; and the greater than or equal to 50 category decreases by 18.8% from 8.7 deaths per 100 waitlist years at 2007 to 7.1 deaths per 100 waitlist years at 2018. — **Figure PA 22. 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 12.4% from 6.5 deaths per 100 waitlist years at 2007 to 5.7 deaths per 100 waitlist years at 2018; the black category decreases by 24.1% from 9.3 deaths per 100 waitlist years at 2007 to 7 deaths per 100 waitlist years at 2018; and the other/unknown category decreases by 21.8% from 6.1 deaths per 100 waitlist years at 2007 to 4.8 deaths per 100 waitlist years at 2018. — **Figure PA 23. 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 14.7% from 6.9 deaths per 100 waitlist years at 2007 to 5.8 deaths per 100 waitlist years at 2018; the pak category decreases by 20.9% from 2.2 deaths per 100 waitlist years at 2007 to 1.7 deaths per 100 waitlist years at 2018; the pta category decreases by 52.6% from 4.1 deaths per 100 waitlist years at 2007 to 1.9 deaths per 100 waitlist years at 2018; and the spk category decreases by 20.6% from 9.5 deaths per 100 waitlist years at 2007 to 7.6 deaths per 100 waitlist years at 2018. — **Figure PA 24. 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 2017-2018, by dsa, the values range from 0.00 to 20.01. — **Figure PA 25. Pretransplant mortality rates among adults waitlisted for pancreas transplant in 2017-2018, 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 100.0% from 1 percent at 2007 to 0 percent at 2018; the pta category increases by 35.1% from 6.7 percent at 2007 to 9.1 percent at 2018; the spk category increases by 58.7% from 6.2 percent at 2007 to 9.9 percent at 2018; and the all category increases by 64.9% from 4.6 percent at 2007 to 7.6 percent at 2018. — **Figure PA 26. 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 increases by 28.0% from 5.2 percent at 2007 to 6.7 percent at 2018; the 35 to 49 category increases by 49.1% from 4.8 percent at 2007 to 7.2 percent at 2018; and the greater than or equal to 50 category increases by 114.6% from 3.9 percent at 2007 to 8.3 percent at 2018. — **Figure PA 27. 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 all category decreases by 22.7% from 1333 count at 2007 to 1030 count at 2018; the less than 18 category decreases by 31.6% from 326 count at 2007 to 223 count at 2018; the 18 to 34 category decreases by 12.2% from 764 count at 2007 to 671 count at 2018; the 35 to 49 category decreases by 41.4% from 227 count at 2007 to 133 count at 2018; and the greater than or equal to 50 category decreases by 81.2% from 16 count at 2007 to 3 count at 2018. — **Figure PA 28. 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 decreases by 11.5% from 24.5 percent at 2007 to 21.7 percent at 2018; the 18 to 34 category increases by 13.7% from 57.3 percent at 2007 to 65.1 percent at 2018; the 35 to 49 category decreases by 24.2% from 17 percent at 2007 to 12.9 percent at 2018; and the greater than or equal to 50 category decreases by 75.7% from 1.2 percent at 2007 to 0.3 percent at 2018. — **Figure PA 29. 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 sex; the male category is 66.4 percent at 2007 and remains relatively constant with a value of 68.6 percent at 2018; and the female category is 33.6 percent at 2007 and remains relatively constant with a value of 31.4 percent at 2018. — **Figure PA 30. Distribution of deceased pancreas donors by sex**
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 65.6 percent at 2007 and remains relatively constant with a value of 60.8 percent at 2018; the black category increases by 25.9% from 16.4 percent at 2007 to 20.7 percent at 2018; the hispanic category is 15.1 percent at 2007 and remains relatively constant with a value of 15 percent at 2018; and the other/unknown category increases by 19.5% from 2.9 percent at 2007 to 3.5 percent at 2018. — **Figure PA 31. 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 is 18.1 percent at 2007 and remains relatively constant with a value of 17.1 percent at 2018; the 18 to 34 category decreases by 15.3% from 24 percent at 2007 to 20.3 percent at 2018; the 35 to 49 category decreases by 30.9% from 43.4 percent at 2007 to 30 percent at 2018; and the greater than or equal to 50 category decreases by 31.8% from 83.8 percent at 2007 to 57.1 percent at 2018. — **Figure PA 32. 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 30.9% from 31.3 percent at 2007 to 21.7 percent at 2018; the black category decreases by 33.7% from 27.7 percent at 2007 to 18.4 percent at 2018; and the other/unknown category decreases by 13.6% from 26.6 percent at 2007 to 23 percent at 2018. — **Figure PA 33. 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 38.2% from 17.6 percent at 2007 to 10.9 percent at 2018; the 18.5 to less than 25 category decreases by 18.0% from 21.5 percent at 2007 to 17.6 percent at 2018; the 25 to less than 30 category decreases by 28.2% from 34 percent at 2007 to 24.5 percent at 2018; the 30 to less than 35 category decreases by 20.7% from 53.1 percent at 2007 to 42.1 percent at 2018; and the greater than or equal to 35 category decreases by 52.5% from 84.2 percent at 2007 to 40 percent at 2018. — **Figure PA 34. 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 decreases by 41.8% from 37.1 percent at 2007 to 21.6 percent at 2018; and the not increased risk category decreases by 28.3% from 29.5 percent at 2007 to 21.1 percent at 2018. — **Figure PA 35. 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 is 27.8 percent of donors at 2007 and remains relatively constant with a value of 27.9 percent of donors at 2018; the black race category increases by 25.9% from 16.4 percent of donors at 2007 to 20.7 percent of donors at 2018; the asian race category increases by 24.4% from 2 percent of donors at 2007 to 2.4 percent of donors at 2018; the female category is 33.6 percent of donors at 2007 and remains relatively constant with a value of 31.4 percent of donors at 2018; the bmi greater than 25 kg/m2 category is 35.1 percent of donors at 2007 and remains relatively constant with a value of 36.5 percent of donors at 2018; the terminal scr greater than 2.5 mg/dl category increases by 10.4% from 2.6 percent of donors at 2007 to 2.8 percent of donors at 2018; the dcd category increases by 29.4% from 1.9 percent of donors at 2007 to 2.4 percent of donors at 2018; and the cva death category decreases by 39.9% from 15.8 percent of donors at 2007 to 9.5 percent of donors at 2018. — **Figure PA 36. 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 of transplanted pancreata.; the pak category is 1 donor risk index at 2007 and remains relatively constant with a value of 1 donor risk index at 2018; the pta category is 1.2 donor risk index at 2007 and remains relatively constant with a value of 1.2 donor risk index at 2018; and the spk category is 1.1 donor risk index at 2007 and remains relatively constant with a value of 1.1 donor risk index at 2018. — **Figure PA 37. Average pancreas donor risk index of transplanted pancreata.**
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 155.3% from 13.8 percent at 2007 to 35.2 percent at 2018; the cva/stroke category decreases by 39.9% from 15.8 percent at 2007 to 9.5 percent at 2018; the head trauma category decreases by 22.1% from 67.5 percent at 2007 to 52.6 percent at 2018; the cns tumor category increases by 81.2% from 0.4 percent at 2007 to 0.7 percent at 2018; and the other category decreases by 21.6% from 2.5 percent at 2007 to 1.9 percent at 2018. — **Figure PA 38. 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 73.9% from 261 transplants at 2007 to 68 transplants at 2018; the pta category decreases by 40.1% from 207 transplants at 2007 to 124 transplants at 2018; the spk category is 864 transplants at 2007 and remains relatively constant with a value of 835 transplants at 2018; and the all category decreases by 22.9% from 1332 transplants at 2007 to 1027 transplants at 2018. — **Figure PA 39. 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 48.4% from 62 transplants at 2007 to 32 transplants at 2018; the 18 to 34 category decreases by 11.0% from 245 transplants at 2007 to 218 transplants at 2018; the 35 to 49 category decreases by 28.4% from 753 transplants at 2007 to 539 transplants at 2018; and the greater than or equal to 50 category decreases by 12.5% from 272 transplants at 2007 to 238 transplants at 2018. — **Figure PA 40. 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 21.7% from 784 transplants at 2007 to 614 transplants at 2018; and the female category decreases by 24.6% from 548 transplants at 2007 to 413 transplants at 2018. — **Figure PA 41. 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 47.0% from 1033 transplants at 2007 to 547 transplants at 2018; the black category increases by 69.3% from 163 transplants at 2007 to 276 transplants at 2018; and the other/unknown category increases by 50.0% from 136 transplants at 2007 to 204 transplants at 2018. — **Figure PA 42. 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 28.9% from 1112 transplants at 2007 to 791 transplants at 2018; the diabetes type 2 category increases by 153.4% from 58 transplants at 2007 to 147 transplants at 2018; and the other/unknown category decreases by 45.1% from 162 transplants at 2007 to 89 transplants at 2018. — **Figure PA 43. 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 38.9% from 72 transplants at 2007 to 44 transplants at 2018; the 18.5 to less than 25 category decreases by 30.1% from 657 transplants at 2007 to 459 transplants at 2018; the 25 to less than 28 category decreases by 16.2% from 296 transplants at 2007 to 248 transplants at 2018; the 28 to less than 30 category is 138 transplants at 2007 and remains relatively constant with a value of 146 transplants at 2018; the greater than or equal to 30 category decreases by 18.2% from 159 transplants at 2007 to 130 transplants at 2018; and the unknown category decreases by 100.0% from 10 transplants at 2007 to 0 transplants at 2018. — **Figure PA 44. 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 18.7% from 10.2 percent at 2007 to 8.3 percent at 2018; the t to cell depleting category increases by 22.7% from 68.1 percent at 2007 to 83.6 percent at 2018; and the none category decreases by 48.6% from 23.1 percent at 2007 to 11.9 percent at 2018. — **Figure PA 45. 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 12.2% from 53.9 percent at 2007 to 60.5 percent at 2018; the tac mmf category increases by 25.2% from 25.4 percent at 2007 to 31.8 percent at 2018; the tac steroid category is 2.2 percent at 2007 and remains relatively constant with a value of 2.3 percent at 2018; the other category decreases by 66.9% from 16.4 percent at 2007 to 5.4 percent at 2018; and the none reported category decreases by 100.0% from 2.2 percent at 2007 to 0 percent at 2018. — **Figure PA 46. 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 10.1% from 49.4 percent at 2007 to 54.4 percent at 2018; the 1 to less than 20% category decreases by 49.2% from 29 percent at 2007 to 14.7 percent at 2018; the 20 to less than 80% category increases by 32.5% from 17.8 percent at 2007 to 23.5 percent at 2018; the 80 to 100% category increases by 90.4% from 3.9 percent at 2007 to 7.4 percent at 2018; and the unknown category is 0 percent at 2007 and is percent at 2018. — **Figure PA 47. 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 32.6% from 53.7 percent at 2007 to 71.2 percent at 2018; the 1 to less than 20% category decreases by 60.7% from 23.1 percent at 2007 to 9.1 percent at 2018; the 20 to less than 80% category decreases by 12.7% from 13.9 percent at 2007 to 12.1 percent at 2018; the 80 to 100% category decreases by 18.2% from 9.3 percent at 2007 to 7.6 percent at 2018; and the unknown category is 0 percent at 2007 and is percent at 2018. — **Figure PA 48. 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 62.6 percent at 2007 and remains relatively constant with a value of 68 percent at 2018; the 1 to less than 20% category decreases by 39.4% from 20.1 percent at 2007 to 12.2 percent at 2018; the 20 to less than 80% category increases by 49.1% from 11.2 percent at 2007 to 16.7 percent at 2018; the 80 to 100% category decreases by 46.6% from 5.9 percent at 2007 to 3.1 percent at 2018; and the unknown category decreases by 100.0% from 0.2 percent at 2007 to 0 percent at 2018. — **Figure PA 49. 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, 2014-2018, the 0 group is 0.26 percent; the 1 group is 0.52 percent; the 2 group is 4.66 percent; the 3 group is 10.88 percent; the 4 group is 27.20 percent; the 5 group is 36.79 percent; the 6 group is 19.69 percent; and the unk. group is 0.00 percent. — **Figure PA 50. Total HLA A, B, and DR mismatches among adult pancreas transplant recipients, 2014-2018**
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 2007 and remains relatively constant with a value of 1 transplants per center at 2018; the 25th category is 3 transplants per center at 2007 and remains relatively constant with a value of 3 transplants per center at 2018; the median category is 6 transplants per center at 2007 and remains relatively constant with a value of 6 transplants per center at 2018; the 75th category is 10 transplants per center at 2007 and remains relatively constant with a value of 10 transplants per center at 2018; and the 95th category decreases by 12.9% from 31 transplants per center at 2007 to 27 transplants per center at 2018. — **Figure PA 51. 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 is 3.3 percent of transplants at 2007 and remains relatively constant with a value of 3.6 percent of transplants at 2018; the 3 to 10 category is 35.9 percent of transplants at 2007 and remains relatively constant with a value of 37.7 percent of transplants at 2018; the 11 to 24 category increases by 31.0% from 27.2 percent of transplants at 2007 to 35.6 percent of transplants at 2018; and the greater than or equal to 25 category decreases by 31.2% from 33.6 percent of transplants at 2007 to 23.1 percent of transplants at 2018. — **Figure PA 52. 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 19.9% from 13.1 percent at 2007-2008 to 10.5 percent at 2017-2018; the pta category decreases by 44.2% from 15.7 percent at 2007-2008 to 8.7 percent at 2017-2018; the spk to ki category decreases by 71.3% from 4.2 percent at 2007-2008 to 1.2 percent at 2017-2018; the spk to pa category decreases by 54.8% from 10.9 percent at 2007-2008 to 4.9 percent at 2017-2018; and the all category decreases by 53.0% from 12.4 percent at 2007-2008 to 5.8 percent at 2017-2018. — **Figure PA 53. 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, 2018, are excluded due to insufficient follow-up. Nonrenal multivisceral transplants are excluded.

A line plot for kidney graft failure among adult spk transplant recipients; the 1 to year category decreases by 63.7% from 7.7 percent at 2000 to 2.8 percent at 2017; the 5 to year category decreases by 39.0% from 23.9 percent at 2000 to 14.6 percent at 2013; and the 10 to year category is 40.1 percent at 2000 and remains relatively constant with a value of 36.3 percent at 2008. — **Figure PA 54. Kidney graft failure 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. 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 spk transplant recipients; the 1 to year category decreases by 61.5% from 3.6 percent at 2000 to 1.4 percent at 2017; the 5 to year category decreases by 40.3% from 14.4 percent at 2000 to 8.6 percent at 2013; and the 10 to year category decreases by 16.3% from 23.6 percent at 2000 to 19.7 percent at 2008. — **Figure PA 55. Death censored kidney graft failure 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 78.0% from 7.6 percent at 1995-1998 to 1.7 percent at 2016-2017; the 5 to year category decreases by 49.5% from 37.3 percent at 1995-1998 to 18.8 percent at 2012-2013; and the 10 to year category decreases by 26.7% from 57.8 percent at 1995-1998 to 42.4 percent at 2006-2007. — **Figure PA 56. 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 100.0% from 1.6 percent at 1995-1998 to 0 percent at 2016-2017; the 5 to year category decreases by 38.8% from 17.3 percent at 1995-1998 to 10.6 percent at 2012-2013; and the 10 to year category decreases by 29.2% from 30.3 percent at 1995-1998 to 21.4 percent at 2006-2007. — **Figure PA 57. 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 37.4% from 5.1 percent at 1995-1998 to 3.2 percent at 2016-2017; the 5 to year category decreases by 35.2% from 25.9 percent at 1995-1998 to 16.8 percent at 2012-2013; and the 10 to year category decreases by 23.8% from 48.2 percent at 1995-1998 to 36.7 percent at 2006-2007. — **Figure PA 58. 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 increases by 171.3% from 0.4 percent at 1995-1998 to 1.1 percent at 2016-2017; the 5 to year category decreases by 56.8% from 12.9 percent at 1995-1998 to 5.6 percent at 2012-2013; and the 10 to year category decreases by 32.9% from 28.2 percent at 1995-1998 to 19 percent at 2006-2007. — **Figure PA 59. 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 2007 and remains relatively constant with a value of 0 patients (in thousands) at 2018; the 18 to 49 category increases by 22.8% from 12.8 patients (in thousands) at 2007 to 15.8 patients (in thousands) at 2018; the greater than or equal to 50 category increases by 73.9% from 1.7 patients (in thousands) at 2007 to 3 patients (in thousands) at 2018; and the all category increases by 28.8% from 14.6 patients (in thousands) at 2007 to 18.8 patients (in thousands) at 2018. — **Figure PA 60. 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, 2016-2017, the pak group is 11.69 percent; the pta group is 19.31 percent; the spk group is 12.37 percent; and the all group is 12.85 percent. — **Figure PA 61. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by transplant type, 2016-2017**
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 agent 2016-2017, the il2-ra group is 10.29 percent; the tcd group is 13.29 percent; and the no agents group is 8.64 percent. — **Figure PA 62. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by induction agent 2016-2017**
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, 2006-2016; 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 pancreas after kidney transplant by recipient EBV status at transplant, 2006-2016**
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, 2006-2016; 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 64. Incidence of PTLD among adult recipients of pancreas transplant alone by recipient EBV status at transplant, 2006-2016**
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, 2006-2016; 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 65. Incidence of PTLD among adult recipients of simultaneous kidney-pancreas transplant by recipient EBV status at transplant, 2006-2016**
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 46.8% from 5.6 percent at 1995-1998 to 3 percent at 2016-2017; the pta category decreases by 66.5% from 4.5 percent at 1995-1998 to 1.5 percent at 2016-2017; and the spk category decreases by 59.1% from 5.8 percent at 1995-1998 to 2.4 percent at 2016-2017. — **Figure PA 66. 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 52.9% from 19.4 percent at 1995-1998 to 9.2 percent at 2012-2013; the pta category decreases by 55.2% from 23.3 percent at 1995-1998 to 10.5 percent at 2012-2013; and the spk category decreases by 47.7% from 15.4 percent at 1995-1998 to 8 percent at 2012-2013. — **Figure PA 67. 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 29.1% from 37.8 percent at 1995-1998 to 26.8 percent at 2006-2007; the pta category decreases by 44.6% from 36.3 percent at 1995-1998 to 20.1 percent at 2006-2007; and the spk category decreases by 17.1% from 30.5 percent at 1995-1998 to 25.3 percent at 2006-2007. — **Figure PA 68. Patient death at ten years among adult pancreas transplant recipients**
Outcomes are computed using unadjusted Kaplan-Meier methods. Transplant recipients are followed from date of transplant to the earlier of death or 10 years posttransplant. Only first pancreas transplant is considered. PAK recipients without a record of previous kidney or kidney-pancreas transplant are reclassified as PTA.

A line plot for patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, by transplant type; the pak category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 91.7 percent at 60 Months post-transplant; the pta category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 90.2 percent at 60 Months post-transplant; the spk category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 91.6 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 91.5 percent at 60 Months post-transplant. — **Figure PA 69. Patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, by transplant type**
Patient survival estimated using unadjusted Kaplan-Meier methods. For recipients of more than one transplant during the period, only the first is considered.

A line plot for patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, by diagnosis; the diabetes type 1 category is 100 percent at 0 Months post-transplant and remains relatively constant with a value of 91.1 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 95.2 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 91.5 percent at 60 Months post-transplant. — **Figure PA 70. Patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, 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, 2011-2013, 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 91.5 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 90.9 percent at 60 Months post-transplant. — **Figure PA 71. Patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, 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, 2011-2013, by recipients — **Figure PA 72. Patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, 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, 2018**
Candidates waiting for transplant on December 31, 2018, regardless of first listing date; multiple listings are collapsed. Distance is computed from candidate's home zip code to the transplant center.
Characteristic	PAK, N	PAK, Pct	PTA, N	PTA, Pct	SPK, N	SPK, Pct
Age: 18-34 years	33	11.8%	84	22.9%	322	20.2%
Age: 35-49 years	158	56.6%	177	48.2%	843	53.0%
Age: 50-60 years	75	26.9%	86	23.4%	373	23.4%
Age: > 60 years	13	4.7%	20	5.4%	53	3.3%
Sex: Female	135	48.4%	191	52.0%	732	46.0%
Sex: Male	144	51.6%	176	48.0%	859	54.0%
Race/ethnicity: White	187	67.0%	290	79.0%	836	52.5%
Race/ethnicity: Black	48	17.2%	29	7.9%	444	27.9%
Race/ethnicity: Hispanic	38	13.6%	33	9.0%	239	15.0%
Race/ethnicity: Asian	5	1.8%	9	2.5%	52	3.3%
Race/ethnicity: Other/unknown	1	0.4%	6	1.6%	20	1.3%
Geography: Metropolitan	239	85.7%	298	81.2%	1299	81.6%
Geography: Non-metro	40	14.3%	69	18.8%	292	18.4%
Distance: < 50 miles	179	64.2%	178	48.5%	959	60.3%
Distance: 50-<100 miles	47	16.8%	60	16.3%	290	18.2%
Distance: 100-<150 miles	20	7.2%	34	9.3%	146	9.2%
Distance: 150-<250 miles	18	6.5%	26	7.1%	117	7.4%
Distance: ≥ 250 miles	14	5.0%	64	17.4%	74	4.7%
Distance: Unknown	1	0.4%	5	1.4%	5	0.3%
BMI: < 18.5 kg/m²	5	1.8%	13	3.5%	24	1.5%
BMI: 18.5-< 25 kg/m²	107	38.4%	160	43.6%	588	37.0%
BMI: 25-< 28 kg/m²	65	23.3%	82	22.3%	400	25.1%
BMI: 28-< 30 kg/m²	40	14.3%	41	11.2%	245	15.4%
BMI: 30-< 35 kg/m²	52	18.6%	59	16.1%	265	16.7%
BMI: ≥ 35 kg/m²	8	2.9%	12	3.3%	68	4.3%
BMI: Unknown	2	0.7%	0	0.0%	1	0.1%
All candidates	279	100.0%	367	100.0%	1591	100.0%

**Table PA 2. Clinical characteristics of adults on the pancreas transplant waiting list on December 31, 2018**
Candidates waiting for transplant on December 31, 2018, 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	243	87.1%	292	79.6%	1228	77.2%
Diagnosis: Diabetes type 2	29	10.4%	21	5.7%	273	17.2%
Diagnosis: Other	7	2.5%	54	14.7%	90	5.7%
Blood type: A	109	39.1%	152	41.4%	482	30.3%
Blood type: B	28	10.0%	42	11.4%	278	17.5%
Blood type: AB	10	3.6%	8	2.2%	60	3.8%
Blood type: O	132	47.3%	165	45.0%	771	48.5%
CPRA: < 1%	145	52.0%	229	62.4%	909	57.1%
CPRA: 1-< 20%	27	9.7%	25	6.8%	133	8.4%
CPRA: 20-< 80%	45	16.1%	50	13.6%	297	18.7%
CPRA: 80-< 98%	31	11.1%	24	6.5%	103	6.5%
CPRA: 98-100%	25	9.0%	38	10.4%	149	9.4%
CPRA: Unknown	6	2.2%	1	0.3%	0	0.0%
All candidates	279	100.0%	367	100.0%	1591	100.0%

**Table PA 3. Listing characteristics of adults on the pancreas transplant waiting list on December 31, 2018**
Candidates waiting for transplant on December 31, 2018, 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	188	67.4%	321	87.5%	1516	95.3%
Transplant history: Retransplant	91	32.6%	46	12.5%	75	4.7%
Wait time: < 1 year	70	25.1%	133	36.2%	708	44.5%
Wait time: 1-< 2 years	60	21.5%	79	21.5%	386	24.3%
Wait time: 2-< 3 years	37	13.3%	40	10.9%	169	10.6%
Wait time: 3-< 4 years	20	7.2%	31	8.4%	122	7.7%
Wait time: 4-< 5 years	16	5.7%	29	7.9%	81	5.1%
Wait time: ≥ 5 years	76	27.2%	55	15.0%	125	7.9%
All candidates	279	100.0%	367	100.0%	1591	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	2016	2017	2018
Patients at start of year	399	364	328
Patients added during year	122	114	95
Patients removed during year	157	150	144
Patients at end of year	364	328	279

**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	2016	2017	2018
Patients at start of year	417	373	370
Patients added during year	191	211	198
Patients removed during year	234	214	201
Patients at end of year	374	370	367

**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	2016	2017	2018
Patients at start of year	1917	1723	1653
Patients added during year	1116	1167	1192
Patients removed during year	1308	1236	1254
Patients at end of year	1725	1654	1591

**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	2016	2017	2018
Deceased donor transplant	55	64	48
Living donor kidney transplant	0	0	0
Patient died	3	5	5
Patient refused transplant	11	17	8
Improved, transplant not needed	3	0	1
Too sick for transplant	23	15	15
Changed to kidney-pancreas list	4	0	5
Other	58	49	62

**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	2016	2017	2018
Deceased donor transplant	126	117	113
Living donor kidney transplant	0	0	0
Patient died	7	12	4
Patient refused transplant	9	9	4
Improved, transplant not needed	4	6	5
Too sick for transplant	16	12	13
Changed to kidney-pancreas list	4	6	7
Other	68	52	55

**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	2016	2017	2018
Deceased donor transplant	818	818	855
Living donor kidney transplant	77	64	70
Patient died	109	85	105
Patient refused transplant	13	9	10
Improved, transplant not needed	12	11	7
Too sick for transplant	93	88	69
Changed to kidney-pancreas list	0	0	0
Other	186	161	138

**Table PA 10. Demographic characteristics of adult pancreas transplant recipients, 2018**
Pancreas transplant recipients, including retransplants. Distance is computed from recipient's home zip code to the transplant center.
Characteristic	PAK, N	PAK, Pct	PTA, N	PTA, Pct	SPK, N	SPK, Pct	All, N	All, Pct
Age: 18-34 years	15	22.1%	26	28.0%	177	21.2%	218	21.9%
Age: 35-49 years	30	44.1%	45	48.4%	464	55.6%	539	54.2%
Age: 50-60 years	21	30.9%	17	18.3%	161	19.3%	199	20.0%
Age: > 60 years	2	2.9%	5	5.4%	32	3.8%	39	3.9%
Sex: Female	40	58.8%	49	52.7%	313	37.5%	402	40.4%
Sex: Male	28	41.2%	44	47.3%	521	62.5%	593	59.6%
Race/ethnicity: White	48	70.6%	81	87.1%	404	48.4%	533	53.6%
Race/ethnicity: Black	11	16.2%	2	2.2%	250	30.0%	263	26.4%
Race/ethnicity: Hispanic	7	10.3%	8	8.6%	139	16.7%	154	15.5%
Race/ethnicity: Asian	1	1.5%	1	1.1%	23	2.8%	25	2.5%
Race/ethnicity: Other/unknown	1	1.5%	1	1.1%	18	2.2%	20	2.0%
BMI: < 18.5 kg/m²	1	1.5%	5	5.4%	18	2.2%	24	2.4%
BMI: 18.5-< 25 kg/m²	37	54.4%	37	39.8%	374	44.8%	448	45.0%
BMI: 25-< 28 kg/m²	14	20.6%	18	19.4%	216	25.9%	248	24.9%
BMI: 28-< 30 kg/m²	10	14.7%	12	12.9%	123	14.7%	145	14.6%
BMI: 30-< 35 kg/m²	6	8.8%	19	20.4%	94	11.3%	119	12.0%
BMI: ≥ 35 kg/m²	0	0.0%	2	2.2%	9	1.1%	11	1.1%
Insurance: Private	30	44.1%	67	72.0%	329	39.4%	426	42.8%
Insurance: Medicare	31	45.6%	13	14.0%	423	50.7%	467	46.9%
Insurance: Other government	6	8.8%	12	12.9%	76	9.1%	94	9.4%
Insurance: Unknown	1	1.5%	1	1.1%	6	0.7%	8	0.8%
Geography: Metropolitan	57	83.8%	75	80.6%	685	82.1%	817	82.1%
Geography: Non-metro	11	16.2%	18	19.4%	149	17.9%	178	17.9%
Distance: < 50 miles	40	58.8%	35	37.6%	518	62.1%	593	59.6%
Distance: 50-<100 miles	14	20.6%	17	18.3%	149	17.9%	180	18.1%
Distance: 100-<150 miles	2	2.9%	15	16.1%	71	8.5%	88	8.8%
Distance: 150-<250 miles	4	5.9%	8	8.6%	52	6.2%	64	6.4%
Distance: ≥ 250 miles	7	10.3%	17	18.3%	37	4.4%	61	6.1%
Distance: Unknown	1	1.5%	1	1.1%	7	0.8%	9	0.9%
All recipients	68	100.0%	93	100.0%	834	100.0%	995	100.0%

**Table PA 11. Clinical characteristics of adult pancreas transplant recipients, 2018**
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	60	88.2%	62	66.7%	667	80.0%	789	79.3%
Diagnosis: Diabetes type 2	7	10.3%	1	1.1%	139	16.7%	147	14.8%
Diagnosis: Other	1	1.5%	30	32.3%	28	3.4%	59	5.9%
Blood type: A	28	41.2%	46	49.5%	282	33.8%	356	35.8%
Blood type: B	8	11.8%	13	14.0%	100	12.0%	121	12.2%
Blood type: AB	4	5.9%	1	1.1%	21	2.5%	26	2.6%
Blood type: O	28	41.2%	33	35.5%	431	51.7%	492	49.4%
All recipients	68	100.0%	93	100.0%	834	100.0%	995	100.0%

**Table PA 12. Transplant characteristics of adult pancreas transplant recipients, 2018**
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	10	14.7%	27	29.0%	139	16.7%	176	17.7%
Wait time: 31-60 days	4	5.9%	15	16.1%	95	11.4%	114	11.5%
Wait time: 61-90 days	1	1.5%	5	5.4%	86	10.3%	92	9.2%
Wait time: 3-< 6 months	8	11.8%	15	16.1%	159	19.1%	182	18.3%
Wait time: 6-< 12 months	17	25.0%	12	12.9%	128	15.3%	157	15.8%
Wait time: 1-< 2 years	16	23.5%	11	11.8%	121	14.5%	148	14.9%
Wait time: 2-< 3 years	6	8.8%	4	4.3%	51	6.1%	61	6.1%
Wait time: ≥ 3 years	6	8.8%	4	4.3%	55	6.6%	65	6.5%
Transplant history: First	51	75.0%	85	91.4%	823	98.7%	959	96.4%
Transplant history: Retransplant	17	25.0%	8	8.6%	11	1.3%	36	3.6%
Tx type: Kidney-pancreas	0	0.0%	0	0.0%	828	99.3%	828	83.2%
Tx type: Pancreas only	68	100.0%	66	71.0%	0	0.0%	134	13.5%
Tx type: Other	0	0.0%	27	29.0%	6	0.7%	33	3.3%
All recipients	68	100.0%	93	100.0%	834	100.0%	995	100.0%

**Table PA 13. Adult pancreas donor-recipient serology matching, 2016-2018**
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. Donor HCV NAT data are shown by recipient HCV antibody status. CMV, cytomegalovirus; EBV, Epstein-Barr virus; HBsAg, hepatitis B surace antigen; HCV, hepatitis C virus; HIV, human immunodeficiency virus; NAT, nucleic acid test.
Donor	Recipient	CMV	EBV	HBsAg	HCV antibody	HCV NAT
D-	R-	19.9%	1.7%	97.9%	96.9%	97.0%
D-	R+	21.9%	11.5%	1.2%	2.2%	2.1%
D-	R unk	0.2%	1.5%	0.7%	0.7%	0.7%
D+	R-	25.9%	7.2%	0.1%	0.2%	0.1%
D+	R+	31.3%	76.5%	0.0%	0.1%	0.1%
D+	R unk	0.2%	1.6%	0.0%	0.0%	0.0%
D unk	R-	0.3%	0.0%	0.1%	0.0%	0.0%
D unk	R+	0.3%	0.1%	0.0%	0.0%	0.0%
D unk	R unk	0.0%	0.0%	0.0%	0.0%	0.0%