First World Consensus Conference on pancreas transplantation: Part II - recommendations

Ugo Boggi¹, Fabio Vistoli¹, Axel Andres², Helmut P Arbogast³, Lionel Badet⁴, Walter Baronti⁵, Stephen T Bartlett⁶, Enrico Benedetti⁷, Julien Branchereau⁸, George W Burke 3rd⁹, Fanny Buron¹⁰, Rossana Caldara¹¹, Massimo Cardillo¹², Daniel Casanova¹³, Federica Cipriani¹⁴, Matthew Cooper¹⁵, Adamasco Cupisti⁵, Josè Davide¹⁶, Cinthia Drachenberg¹⁷, Eelco J P de Koning¹⁸, Giuseppe Maria Ettorre¹⁹, Laureano Fernandez Cruz²⁰, Jonathan A Fridell²¹, Peter J Friend²², Lucrezia Furian²³, Osama A Gaber²⁴, Angelika C Gruessner²⁵, Rainer W G Gruessner²⁶, Jenny E Gunton²⁷, Duck-Jong Han²⁸, Sara Iacopi¹, Emanuele Federico Kauffmann¹, Dixon Kaufman²⁹, Takashi Kenmochi³⁰, Hussein A Khambalia³¹, Quirino Lai³², Robert M Langer³³, Paola Maffi¹¹, Lorella Marselli⁵, Francesco Menichetti³⁴, Mario Miccoli⁵, Shruti Mittal²², Emmanuel Morelon¹⁰, Niccolò Napoli¹, Flavia Neri²³, Jose Oberholzer³⁵, Jon S Odorico²⁹, Robert Öllinger³⁶, Gabriel Oniscu³⁷, Giuseppe Orlando³⁸, Monica Ortenzi³⁹, Marcelo Perosa⁴⁰, Vittorio Grazio Perrone¹, Henry Pleass⁴¹, Robert R Redfield²⁹, Claudio Ricci⁴², Paolo Rigotti²³, R Paul Robertson⁴³, Lainie F Ross⁴⁴, Massimo Rossi³², Frantisek Saudek⁴⁵, Joseph R Scalea⁶, Peter Schenker⁴⁶, Antonio Secchi¹¹, Carlo Socci⁴⁷, Donzilia Sousa Silva¹⁶, Jean Paul Squifflet⁴⁸, Peter G Stock⁴⁹, Robert J Stratta³⁸, Chiara Terrenzio⁵, Pablo Uva⁵⁰, Christopher J E Watson⁵¹, Steven A White⁵², Piero Marchetti⁵, Raja Kandaswamy⁵³, Thierry Berney²

Affiliations

¹ Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
² Division of Transplantation, Department of Surgery, University of Geneva, Geneva, Switzerland.
³ Department of General, Visceral and Transplant Surgery, Grosshadern Medical Centre, University of Munich, Munich, Germany.
⁴ Department of Urology and Transplantation, E. Herriot Hospital/Lyon 1 University, Lyon, France.
⁵ Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
⁶ Division of Transplantation, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
⁷ Department of Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
⁸ Department of Urology, Nantes University Hospital, CHU de Nantes, Nantes, France.
⁹ Division of Kidney-Pancreas Transplantation, Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami Transplant Institute, Miami, Florida, USA.
¹⁰ Department of Transplantation, Nephrology and Clinical Immunology, Hospital/Lyon 1 University, Lyon, France.
¹¹ Internal Medicine and Transplantation, Scientific Institute San Raffaele, Milan, Italy.
¹² Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy.
¹³ Department Surgery, University of Cantabria, Santander, Spain.
¹⁴ Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹⁵ Medstar Georgetown Transplant Institute, Washington, DC, USA.
¹⁶ Division of Transplantation, Centro Hospitalar Universitário do Porto, Institute of Biomedical Sciences Abel Salazar, University of Porto and Pancreas Transplantation Program, Porto, Portugal.
¹⁷ Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹⁸ Department of Medicine and Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.
¹⁹ Transplantation Department, S. Camillo-Forlanini Hospital, Rome, Italy.
²⁰ Hospital Clinic University of Barcelona, Barcelona, Spain.
²¹ Department of Surgery, Indiana University, Indianapolis, Indiana, USA.
²² Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England, UK.
²³ Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
²⁴ J.C. Walter Jr. Center for Transplantation, Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA.
²⁵ Department of Medicine, SUNY Downstate Medical Center, The State University of New York, Brooklyn, New York, USA.
²⁶ Department of Surgery, SUNY Downstate Medical Center, The State University of New York, Brooklyn, New York, USA.
²⁷ Centre for Diabetes, Obesity and Endocrinology, Westmead Institute for Medical Research, Westmead, Australia.
²⁸ Transplantation Department, Asan Medical Center, Ulsan University, Seoul, South Korea.
²⁹ Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
³⁰ Department of Organ Transplant Surgery, Fujita Health University, Toyoake, Japan.
³¹ Department of Transplantation, Manchester Foundations Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK.
³² General Surgery and Orgn Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinico of Rome, Rome, Italy.
³³ Ordensklinikum Elisabethinen, University of Linz, Linz, Austria.
³⁴ Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
³⁵ Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
³⁶ Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
³⁷ Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, Scotland, UK.
³⁸ Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³⁹ Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
⁴⁰ Pancreas Transplant Program, Abdominal Organ Transplantation Department, Leforte Hospital Sao Paulo, Sao Paulo, Brazil.
⁴¹ Department of Surgery, Weastmead Clinical School, University of Sydney, Sydney, Australia.
⁴² Department of Internal Medicine and Surgery, University of Bologna, Bologna, Italy.
⁴³ Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Washington, Seattle, Washington, USA.
⁴⁴ MacLean Center for Clinical Medical Ethics, Departments of Pediatrics, Medicine and Surgery, University of Chicago, Chicago, Illinois, USA.
⁴⁵ Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
⁴⁶ Department of Surgery, Ruhr-University Bochum, Bochum, Germany.
⁴⁷ Department of Surgery, Scientific Institute San Raffaele, Milan, Italy.
⁴⁸ Department of Abdominal Surgery and Transplantation, University of Liege, Liege, Belgium.
⁴⁹ Division of Transplantation, Department of Surgery, University of California at San Francisco, San Francisco, California, USA.
⁵⁰ Kidney Pancreas Transplantation, Instituto de Trasplantes y Alta Complejidad (ITAC - Nephrology), Buenos Aires, Argentina.
⁵¹ Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, England, UK.
⁵² Department of Hepato-pancreatico-biliary and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, England, UK.
⁵³ Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.

PMID: 34245223
PMCID: PMC8518376
DOI: 10.1111/ajt.16750

First World Consensus Conference on pancreas transplantation: Part II - recommendations

Ugo Boggi et al. Am J Transplant. 2021 Sep.

. 2021 Sep;21 Suppl 3(Suppl 3):17-59.

doi: 10.1111/ajt.16750. Epub 2021 Jul 29.

Authors

Affiliations

¹ Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
² Division of Transplantation, Department of Surgery, University of Geneva, Geneva, Switzerland.
³ Department of General, Visceral and Transplant Surgery, Grosshadern Medical Centre, University of Munich, Munich, Germany.
⁴ Department of Urology and Transplantation, E. Herriot Hospital/Lyon 1 University, Lyon, France.
⁵ Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
⁶ Division of Transplantation, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.
⁷ Department of Surgery, University of Illinois at Chicago College of Medicine, Chicago, Illinois, USA.
⁸ Department of Urology, Nantes University Hospital, CHU de Nantes, Nantes, France.
⁹ Division of Kidney-Pancreas Transplantation, Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami Transplant Institute, Miami, Florida, USA.
¹⁰ Department of Transplantation, Nephrology and Clinical Immunology, Hospital/Lyon 1 University, Lyon, France.
¹¹ Internal Medicine and Transplantation, Scientific Institute San Raffaele, Milan, Italy.
¹² Italian National Transplant Center, Istituto Superiore di Sanità, Rome, Italy.
¹³ Department Surgery, University of Cantabria, Santander, Spain.
¹⁴ Hepatobiliary Surgery Division, IRCCS San Raffaele Scientific Institute, Milan, Italy.
¹⁵ Medstar Georgetown Transplant Institute, Washington, DC, USA.
¹⁶ Division of Transplantation, Centro Hospitalar Universitário do Porto, Institute of Biomedical Sciences Abel Salazar, University of Porto and Pancreas Transplantation Program, Porto, Portugal.
¹⁷ Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
¹⁸ Department of Medicine and Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.
¹⁹ Transplantation Department, S. Camillo-Forlanini Hospital, Rome, Italy.
²⁰ Hospital Clinic University of Barcelona, Barcelona, Spain.
²¹ Department of Surgery, Indiana University, Indianapolis, Indiana, USA.
²² Nuffield Department of Surgical Sciences, University of Oxford, Oxford, England, UK.
²³ Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
²⁴ J.C. Walter Jr. Center for Transplantation, Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA.
²⁵ Department of Medicine, SUNY Downstate Medical Center, The State University of New York, Brooklyn, New York, USA.
²⁶ Department of Surgery, SUNY Downstate Medical Center, The State University of New York, Brooklyn, New York, USA.
²⁷ Centre for Diabetes, Obesity and Endocrinology, Westmead Institute for Medical Research, Westmead, Australia.
²⁸ Transplantation Department, Asan Medical Center, Ulsan University, Seoul, South Korea.
²⁹ Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin, USA.
³⁰ Department of Organ Transplant Surgery, Fujita Health University, Toyoake, Japan.
³¹ Department of Transplantation, Manchester Foundations Hospitals NHS Foundation Trust, Manchester Royal Infirmary, Manchester, UK.
³² General Surgery and Orgn Transplantation Unit, Sapienza University of Rome, Umberto I Polyclinico of Rome, Rome, Italy.
³³ Ordensklinikum Elisabethinen, University of Linz, Linz, Austria.
³⁴ Infectious Disease Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
³⁵ Department of Surgery, University of Virginia, Charlottesville, Virginia, USA.
³⁶ Department of Surgery, Campus Charité-Mitte and Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Berlin, Germany.
³⁷ Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, University of Edinburgh, Edinburgh, Scotland, UK.
³⁸ Department of Surgery, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.
³⁹ Department of General and Emergency Surgery, Polytechnic University of Marche, Ancona, Italy.
⁴⁰ Pancreas Transplant Program, Abdominal Organ Transplantation Department, Leforte Hospital Sao Paulo, Sao Paulo, Brazil.
⁴¹ Department of Surgery, Weastmead Clinical School, University of Sydney, Sydney, Australia.
⁴² Department of Internal Medicine and Surgery, University of Bologna, Bologna, Italy.
⁴³ Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Washington, Seattle, Washington, USA.
⁴⁴ MacLean Center for Clinical Medical Ethics, Departments of Pediatrics, Medicine and Surgery, University of Chicago, Chicago, Illinois, USA.
⁴⁵ Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
⁴⁶ Department of Surgery, Ruhr-University Bochum, Bochum, Germany.
⁴⁷ Department of Surgery, Scientific Institute San Raffaele, Milan, Italy.
⁴⁸ Department of Abdominal Surgery and Transplantation, University of Liege, Liege, Belgium.
⁴⁹ Division of Transplantation, Department of Surgery, University of California at San Francisco, San Francisco, California, USA.
⁵⁰ Kidney Pancreas Transplantation, Instituto de Trasplantes y Alta Complejidad (ITAC - Nephrology), Buenos Aires, Argentina.
⁵¹ Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, England, UK.
⁵² Department of Hepato-pancreatico-biliary and Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, England, UK.
⁵³ Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.

PMID: 34245223
PMCID: PMC8518376
DOI: 10.1111/ajt.16750

Abstract

The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.

Keywords: clinical research/practice; diabetes; pancreas/simultaneous pancreas-kidney transplantation; survey.

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Conflict of interest statement

The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Figures

**FIGURE 1**
Level of evidence and strength of statements. (A) Jury deliberations; (B) expert recommendations.

See this image and copyright information in PMC

References

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First World Consensus Conference on pancreas transplantation: Part II - recommendations

Affiliations

First World Consensus Conference on pancreas transplantation: Part II - recommendations

Authors

Affiliations

Abstract

Conflict of interest statement

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References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical