Background: While kidney transplantation in the elderly diabetic patient is an accepted treatment, pancreas transplants in older patients are controversial. Many centers have an age limit of 60 years or lower in place. The aim of this study was to describe the surgical risk of pancreas transplantation in the elderly and the potential life-years gained by undergoing a pancreas transplant.

Methods: Between 2000 and 2017, 885 diabetic patients 58 years of age or older were listed for a primary deceased donor pancreas transplants in the USA. 75% of patients were listed for a simultaneous pancreas kidney transplant (SPK), 12% previous kidney for a pancreas after kidney (PAK) and 12% for a pancreas transplant alone (PTA). Uni- and multivariate statistical methods were used to assess wait-list mortality, outcomes and life-years gained for older pancreas transplant recipients. Each patient had a potential follow-up of at least 4 years post-transplant.

Results: The 1- and 3-year mortality rates while waiting for a transplant were 9.6% and 32.6% for SPK, 5% and 14% for PAK, and 6.9% and 15.4% for PTA. Of these wait-listed patients, a total of 489 underwent a pancreas transplant (333 SPK,79 PAK, 77 PTA). Table 1 shows the demographics and outcomes for the 3 transplant categories. Patient and pancreas graft survival was not statistically different between the 3 transplant categories.

Conclusions: Pancreas transplants can be safely performed in older patients with excellent patient and graft outcomes. The additional gain in life-years is especially high in SPK recipients. The gain in life-years is not as high in solitary transplants because the mortality on the wait-list is not as high as in SPK patients. The mortality of patients with hypoglycemia remains high at any age and should also be an indication for pancreas transplantation in older, diabetic patients.