Analyzing outcomes following pancreas transplantation: Definition of a failure or failure of a definition.
Robert J StrattaAlan C FarneyJonathan A FridellPublished in: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons (2022)
Pancreas transplantation has an identity crisis and is at a crossroads. Although outcomes continue to improve in each successive era, the number of pancreas transplants performed annually in the United States has been static for several years in spite of increasing numbers of deceased donors. For most practitioners who manage diabetes, pancreas transplantation is considered an extreme measure to control diabetes. With expanded recipient selection (primarily simultaneous pancreas-kidney transplantation) in patients who are older, have a higher BMI, are minorities, or who have a type 2 diabetes phenotype, the controversy regarding type of diabetes detracts from the success of intervention. The absence of a clear and precise definition of pancreas graft failure, particularly one that lacks a measure of glycemic control, inhibits wider application of pancreas transplantation with respect to reporting long-term outcomes, comparing this treatment to alternative therapies, developing listing and allocation policy, and having a better understanding of the patient perspective. It has been suggested that the definition of pancreas graft failure should differ depending on the type of pretransplant diabetes. In this commentary, we discuss current challenges regarding the development of a uniform definition of pancreas graft failure and propose a potential solution to this vexing problem.
Keyphrases
- glycemic control
- type diabetes
- kidney transplantation
- cardiovascular disease
- public health
- randomized controlled trial
- healthcare
- stem cells
- weight loss
- primary care
- ejection fraction
- body mass index
- emergency department
- insulin resistance
- climate change
- end stage renal disease
- physical activity
- case report
- metabolic syndrome
- bone marrow
- weight gain
- skeletal muscle
- peritoneal dialysis
- patient reported