Skip To Main Content
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

Figure PA 1. New adult candidates added to the active pancreas transplant waiting list
Figure PA 2. New adult candidates added to the pancreas transplant waiting list
Figure PA 3. Adults actively listed for pancreas transplant on December 31 each year
Figure PA 4. Adults listed for pancreas transplant on December 31 each year
Figure PA 5. Distribution of adults waiting for pancreas transplant by age
Figure PA 6. Distribution of adults waiting for pancreas transplant by sex
Figure PA 7. Distribution of adults waiting for pancreas transplant by race
Figure PA 8. Distribution of adults waiting for pancreas transplant by diagnosis
Figure PA 9. Distribution of adults waiting for pancreas transplant by waiting time
Figure PA 10. Distribution of adults waiting for pancreas transplant by BMI
Figure PA 11. Distribution of adults waiting for pancreas transplant by intended transplant type
Figure PA 12. Distribution of adults waiting for pancreas transplant by prior pancreas transplant status
Figure PA 13. Deceased donor pancreas transplant rates among adult waitlist candidates by diagnosis
Figure PA 14. Deceased donor pancreas transplant rates among adult waitlist candidates by intended transplant type
Figure PA 15. Three-year outcomes for adults waiting for pancreas after kidney transplant, new listings in 2015
Figure PA 16. Three-year outcomes for adults waiting for pancreas transplant alone, new listings in 2015
Figure PA 17. Three-year outcomes for adults waiting for simultaneous kidney-pancreas transplant, new listings in 2015
Figure PA 18. Median months to pancreas transplant for waitlisted adults
Figure PA 19. Percentage of adults who underwent pancreas after kidney transplant within 2 years of listing in 2016 by DSA
Figure PA 20. Percentage of adults who underwent pancreas transplant alone within 2 years of listing in 2016 by DSA
Figure PA 21. Percentage of adults who underwent simultaneous kidney-pancreas transplant within 2 years of listing in 2016 by DSA
Figure PA 22. Pretransplant mortality rates among adults waitlisted for pancreas transplant by age
Figure PA 23. Pretransplant mortality rates among adults waitlisted for pancreas transplant by race
Figure PA 24. Pretransplant mortality rates among adults waitlisted for pancreas transplant by intended transplant type
Figure PA 25. Pretransplant mortality rates among adults waitlisted for pancreas transplant in 2017-2018, by DSA
Figure PA 26. Deaths within six months after removal among adult pancreas waitlist candidates, by intended transplant type
Figure PA 27. Deaths within six months after removal among adult pancreas waitlist candidates, by age at removal

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

Figure PA 53. Graft failure within the first 90 days posttransplant among adult pancreas transplant recipients
Figure PA 54. Kidney graft failure among adult SPK transplant recipients
Figure PA 55. Death censored kidney graft failure among adult SPK transplant recipients
Figure PA 56. Kidney graft failure among adult PAK transplant recipients with a deceased donor kidney (from time of pancreas transplant)
Figure PA 57. Death-censored kidney graft failure among adult PAK transplant recipients with a deceased donor kidney (from time of pancreas transplant)
Figure PA 58. Kidney graft failure among adult PAK transplant recipients with a living donor kidney (from time of pancreas transplant)
Figure PA 59. Death-censored kidney graft failure among adult PAK transplant recipients with a living donor kidney (from time of pancreas transplant)
Figure PA 60. Recipients alive after pancreas transplant on June 30 of the year, by age at transplant
Figure PA 61. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by transplant type, 2016-2017
Figure PA 62. Incidence of acute rejection by 1 year posttransplant among adult pancreas transplant recipients by induction agent 2016-2017
Figure PA 63. Incidence of PTLD among adult recipients of pancreas after kidney transplant by recipient EBV status at transplant, 2006-2016
Figure PA 64. Incidence of PTLD among adult recipients of pancreas transplant alone by recipient EBV status at transplant, 2006-2016
Figure PA 65. Incidence of PTLD among adult recipients of simultaneous kidney-pancreas transplant by recipient EBV status at transplant, 2006-2016
Figure PA 66. Patient death at one year among adult pancreas transplant recipients
Figure PA 67. Patient death at five years among adult pancreas transplant recipients
Figure PA 68. Patient death at ten years among adult pancreas transplant recipients
Figure PA 69. Patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, by transplant type
Figure PA 70. Patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, by diagnosis
Figure PA 71. Patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, by metropolitan vs. non-metropolitan recipient residence
Figure PA 72. Patient survival among adult deceased donor pancreas transplant recipients, 2011-2013, by recipients' distance from transplant center

Table List

Waiting list

Table PA 1. Demographic characteristics of adults on the pancreas transplant waiting list on December 31, 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 active pancreas transplant waiting list; the pak category decreases by 79.9% from 189 candidates at 2007 to 38 candidates at 2018; the pta category decreases by 53.7% from 229 candidates at 2007 to 106 candidates at 2018; the spk category decreases by 26.4% from 1112 candidates at 2007 to 818 candidates at 2018; and the all category decreases by 37.1% from 1530 candidates at 2007 to 962 candidates at 2018.

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


A line plot for new adult candidates added to the pancreas transplant waiting list; the pak category decreases by 74.0% 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.