Is Pancreas Transplantation Getting Old? Single-Center Experience in an Aging Society

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1 165 Is Pancreas Transplantation Getting Old? Single-Center Experience in an Aging Society Richard Viebahn 1, Harald Klein 2, Bernhard Kraemer 3 and Peter Schenker 1 1 Department of Surgery, Knappschaftskrankenhaus, 2 Department of Endocrinology, Universitätsklinikum Bergmannsheil, 3 Department of Medicine, Marienhospital Herne, Ruhr-University of Bochum, Germany INTRODUCTION would replace islet and kidney function in diabetic patients (1). And, indeed, through different technical standard for people suffering from type 1 diabetes mellitus end stage kidney disease. This stage of diabetic complication takes up to 2 or 3 years to patients were about 35-4 years old when they some countries, including Germany. Some key data about pancreas donors would also change. Especially in pancreas transplantation, the success rate is determined not only by the quality of surgery and medical treatment, but also the health status of the pancreas donor, the cause of death and the donor s age were studied, and the impact of those factors on the success rate good pancreas donor was about 28 years and the cause of death was trauma, preferably with a short ICU-stay (2, 3), and that use of pancreases from 4 years of age or with a non-traumatic cause of organs came from standard donors. The need for enough standard organs can be met in populations with a high birth rate and a pyramidal age distribution, especially in countries, through trauma and accidents. In many European - high life span and low rate of death through trauma and accident, all leading to an aging donor popula- in medical therapies has led to a later onset of diabetic nephropathy. the questions whether: 3. and, if so, whether that age difference of transplantation. MATERIAL AND METHODS The transplant center at the Department of Surgery, Knappschaftskrankenhaus, Ruhr-Uni- transplantation was performed in 1994, and 48 to December 31, 29 (379 SPK, 24 PAK, 5 PTA), as well as more than 1,2 kidney transplantations. Clinical Transplants 29, Terasaki Foundation Laboratory, Los Angeles, California

2 166 VIEBAHN, KLEIN, KRAEMER AND SCHENKER In order to study the demography of pancreas donors and recipients, the database of the transplant national guidelines for pancreas transplantation, donor age was categorized into three groups: was compared between these demographic groups using the Kaplan-Meier method. The demographic data of our transplant population was additionally compared to the donor and recipient data of Eurotransplant and OPTN (3) and IPTR (4). RESULTS Donor Demography Figure 1. Distribution of pancreas donors in 16 years, 2: between 16 and 45 years, 3: above 45 years Our transplant center has registered a total of 47 pancreas donors. The category of donors older donors (Fig. 1). Eurotransplant database, these young pancreas donor ages differently, to make comparison easier, OPTN, ET, and our own donor-age data were Recipient Demography number of pancreas recipients older than program no recipient was older than 45 years. In the recipient population (Fig. 2). Comparable Eurotrans- During this time, the proportion of recipients older Figure 2. Distribution of pancreas recipients in GBBTP between 1994 and 29. 1: recipient age Table 1. Pancreas donors in OPTN, ET and Bochum, 24-28: Donors older than 34 years are OPTN Eurotransplant 29 1 Donor age years Donor age > 34 years

3 167 Donor Age and Pancreas Function years after pancreas transplantation, outcomes seem to be slightly better if the pancreas donor was younger than 16 years, and a little bit worse if the (Fig. 3). Recipient Age and Pancreas Function Donor and Recipient Age and Patient Survival results reported by pancreas transplant programs with much younger donors and recipients (Figs 5 and 6). identical (Fig. 4) years Figure 3. Actuarial pancreas survival in years by donor age in GBBTP between 1994 and Figure 4. Actuarial pancreas survival in years by recipient age in GBBTP between 1994 and years Figure 5. Actuarial patient survival in years by donor age in GBBTP between 1994 and Figure 6. Actuarial patient survival in years by recipient age in GBBTP between 1994 and 29. 1

4 168 VIEBAHN, KLEIN, KRAEMER AND SCHENKER DISCUSSION Germany is a country with an aging society. Whereas the population diagram was strictly pyramidal at the beginning of the 2th century, the demography has changed completely due to a donor statistics of the Deutsche Stiftung Organtransplantation, which is the national OPO for Ger- organ donors with a high multi-organ donation rate. modern industry, the number of deaths caused by international registry of trauma and accident death in the United States, in 28, road accident deaths number was 7 in Spain, 5.5 in Germany and 4 in the Netherlands. (6) It can be speculated that these safety limits, and the use of helmets by the riders of bicycles and motorcycles. for the low rate of young donors and the decreasing proportion of traumatic brain death in Germany, and become more and more common in Germany. In German Ärztekammer age for pancreas donation up to 5 years (7). The reason that the number of older diabetics is increasing in our pancreas transplant program into diabetology and were strongly recommended the onset of diabetic nephropathy has been postponed by 5-1 years. The data presented here show that an aging proportion of older donors and recipients becomes greater and greater. The use of pancreas grafts from donation in other organ procurement organisations shows that these organs can be transplanted with fact that the local organisation for organ donation in Germany has a high rate of shipped organs, In all, the questions propounded for this study No, the rise in age of donors and recipients does pancreas transplantation. In conclusion, these data indicate that successful pancreas transplantation is possible in an aging society (8). ACKNOWLEDGEMENTS Prof. Dr. Waldemar Kozuschek started the Director of the Eurotransplant foundation, was helpful in supplying and interpreting the ET data. Sandra Hajt built up the database and Hans Martin Vaihinger helped edit the manuscript. Thanks to numerous diabetologists and nephrologists who transferred their patients trustfully to our institution.

5 169 SUMMARY FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. 2. Gruessner AC, Sutherland DE. Pancreas transplant outcomes for United States (US) and non-us cases as reported to the United Network for Organ sharing (UNOS) and the International Pancreas Transplant registry (IPTR) as of June 24. Clin Transplant Pancreas transplantation has become the major successful islet replacement therapy in dramatically when pancreas transplantation is combined with transplantation of a kidney. For many years, recipients at our center old, suffered from traumatic brain death, and had a short ICU stay. In more recent years, both REFERENCES data were compared to the corresponding data of Eurotransplant and OPTN, showing a dinstinctly older group of donors and recipients at our center societal factors between Germany and other ET countries and the U.S. Calculation of pancreas graft and patient donor and recipient age. In conclusion, the demography of the German population has a strong impact on the age of donors and recipients at our transplant center: international registries. Despite this, the results of pancreas transplantation at our center are comparable to those in registry data Schenker P, Wunsch A, Ertas N, et al. Long-term results after simultaneous pancreas- kidney transplantation using donors aged 45 years or older. Trans-

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