1
|
Usatin DJ, Perito ER, Posselt AM, Rosenthal P. Under Utilization of Pancreas Transplants in Cystic Fibrosis Recipients in the United Network Organ Sharing (UNOS) Data 1987-2014. Am J Transplant 2016; 16:1620-5. [PMID: 26603034 PMCID: PMC5436302 DOI: 10.1111/ajt.13630] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 10/22/2015] [Accepted: 11/12/2015] [Indexed: 01/25/2023]
Abstract
Despite a high prevalence of pancreatic endocrine and exocrine insufficiency in cystic fibrosis (CF), pancreas transplantation is rarely reported. United Network for Organ Sharing (UNOS) data were used to examine utilization of pancreas transplant and posttransplant outcomes in CF patients. Between 1987-2014, CF patients (N = 4600) underwent 17 liver-pancreas, three lung-pancreas, one liver-lung pancreas, four kidney-pancreas, and three pancreas-only transplants. Of the 303 CF patients who received liver transplantation, 20% had CF-related diabetes (CFRD) before transplantation, and nine of those received a liver-pancreas transplant. Of 4241 CF patients who underwent lung transplantation, 33% had CFRD before transplantation, and three of those received a pancreas transplant. Of 49 CF patients who received a liver-lung transplant, 57% had CFRD before transplantation and one received a pancreas transplant. Posttransplantation diabetes developed in 7% of CF pancreas transplant recipients versus 24% of CF liver and 29% of CF lung recipients. UNOS has no data on pancreas exocrine insufficiency. Two-year posttransplantation survival was 88% after liver-pancreas transplant, 33% after lung-pancreas transplant, and 100% after pancreas-kidney and pancreas-only transplants. Diabetes is common pretransplantation and posttransplantation in CF solid organ transplant recipients, but pancreas transplantation remains rare. Further consideration of pancreas transplant in CF patients undergoing other solid organ transplant may be warranted.
Collapse
Affiliation(s)
- D. J. Usatin
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, San Francisco, San Francisco, CA,Corresponding author: Danielle Usatin,
| | - E. R. Perito
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, San Francisco, San Francisco, CA
| | - A. M. Posselt
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - P. Rosenthal
- Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of California, San Francisco, San Francisco, CA,Department of Surgery, University of California, San Francisco, San Francisco, CA
| |
Collapse
|
2
|
Perito ER, Mohammad S, Rosenthal P, Alonso EM, Ekong UD, Lobritto SJ, Feng S. Posttransplant metabolic syndrome in the withdrawal of immunosuppression in Pediatric Liver Transplant Recipients (WISP-R) pilot trial. Am J Transplant 2015; 15:779-85. [PMID: 25648649 PMCID: PMC4426259 DOI: 10.1111/ajt.13024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 09/04/2014] [Accepted: 09/15/2014] [Indexed: 01/25/2023]
Abstract
Posttransplant metabolic syndrome (PTMS)-obesity, hypertension, elevated triglycerides, low HDL and glucose intolerance-is a major contributor to morbidity after adult liver transplant. This analysis of the Withdrawal of Immunosuppression in Pediatric Liver Transplant Recipients (WISP-R) pilot trial is the first prospective study of PTMS after pediatric liver transplant. Twenty children were enrolled in WISP-R, at median age 8.5 years (IQR 6.4-10.8), and weaned from calcineurin-inhibitor monotherapy. The 12 children who tolerated complete immunosuppression withdrawal were compared to matched historical controls. At baseline, 45% of WISP-R subjects and 58% of controls had at least one component of PTMS. Calcineurin-inhibitor withdrawal in the WISP-R subjects did not impact the prevalence of PTMS components compared to controls. At 5 years, despite weaning off of immunosuppression, 92% of the 12 tolerant WISP-R subjects had at least one PTMS component and 58% had at least two; 33% were overweight or obese, 50% had dyslipidemia, 33% glucose intolerance and 42% systolic hypertension. Overweight/obesity increased the risk of hypertension in all children. Compared to controls, WISP-R tolerant subjects had similar GFR at baseline but did have higher GFR at 2, 3 and 4 years. Further study of PTMS and immunosuppression withdrawal after pediatric liver transplant is warranted.
Collapse
Affiliation(s)
- E. R. Perito
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA
| | - S. Mohammad
- Department of Pediatrics, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - P. Rosenthal
- Department of Pediatrics, UCSF Benioff Children's Hospital, University of California, San Francisco, CA,Department of Surgery, University of California, San Francisco, CA
| | - E. M. Alonso
- Department of Pediatrics, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - U. D. Ekong
- Department of Pediatrics, Children's Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - S. J. Lobritto
- Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY,Department of Surgery, Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY
| | - S. Feng
- Department of Surgery, University of California, San Francisco, CA,Corresponding author: Sandy Feng,
| |
Collapse
|