Outcomes of pancreas transplantation in patients with underlying inflammatory bowel disease: a retrospective case series

Samrat Ray; Anila Yousuf; Atit Dharia; Ghassan Ayoub; Catherine Parmentier; Andrea Norgate; Jeffrey Schiff; Chaya Shwaartz; Markus Selzner; Trevor W Reichman

doi:10.1097/MS9.0000000000000408

Outcomes of pancreas transplantation in patients with underlying inflammatory bowel disease: a retrospective case series

Ann Med Surg (Lond). 2023 Mar 27;85(4):732-737. doi: 10.1097/MS9.0000000000000408. eCollection 2023 Apr.

Authors

Samrat Ray¹, Anila Yousuf¹, Atit Dharia², Ghassan Ayoub^{1

3}, Catherine Parmentier¹, Andrea Norgate¹, Jeffrey Schiff², Chaya Shwaartz^{1

4}, Markus Selzner^{1

4}, Trevor W Reichman^{1

4}

Affiliations

¹ Ajmera Transplant Centre, Toronto General Hospital, University Health Network.
² Division of Nephrology, Department of Medicine.
³ McGill University, Montreal, Quebec, Canada.
⁴ Department of Surgery, University of Toronto, Toronto, Ontario.

Abstract

Despite having emerged as a definitive treatment for diabetes mellitus (DM), pancreas transplantation remains a formidable surgical task owing to complications like graft pancreatitis, enteric leaks, and rejection. This becomes more challenging in the setting of underlying bowel pathology, such as inflammatory bowel disease (IBD), which has a strong immune-genomic association of co-existence with DM. Risk of anastomotic leaks, dose adjustments of immunosuppressants and biologicals, and management of IBD flares constitute some of the major perioperative challenges calling for a protocol-based, systematic, multidisciplinary approach.

Patients and methods: This was a retrospective case series of patients between January 1996 and July 2021, with all patients being followed up until December 2021. All consecutive patients with end-stage DM who underwent pancreas transplantation (alone, simultaneous with kidney transplantation or after kidney transplantation) and had pre-existing IBD were included in the study. A Comparison of 1-, 5-, 10-year survival was done with pancreas transplant recipients without underlying IBD using Kaplan-Meir curves.

Results: Of the total 630 pancreas transplants performed between 1996 and 2021, eight patients had IBD, mostly Crohn's disease. Following pancreas transplantation, two of the eight patients had duodenal leaks, with one a requiring graft pancreatectomy. The 5-year graft survival rate for the cohort was 75% compared to 81.6% for the overall cohort of patients undergoing pancreas transplantation (P=0.48) with a median graft survival of 48.4 months compared to 68.1 months in the latter (P=0.56).

Conclusion: The findings of the series provide a snapshot of the outcome of pancreas transplantation in the background of IBD, suggesting a graft and overall patient survival rates comparable with pancreas transplantation in patients without underlying IBD, with further validation of the findings required in a larger cohort of patients in the future.

Keywords: diabetes mellitus; inflammatory bowel disease; pancreas transplantation.