Report of the International Pancreas Transplant Registry A.C. Gruessner, D.E.R. Sutherland, and R.W.G. Gruessner A S of December 31, 1996, a total of 9012 pancreas transplants have been reported to the International Pancreas Transplant Registry (IPTR). Of these transplants, 6,640 (74%) were performed in the United States, and 2,372 (26%) outside the United States. Since 1995, over 1000 pancreas transplants per year have been reported from the United States alone. As of December 31, 1996, there were 101 pancreas transplant centers in the United States, and 87 outside. All US pancreas transplants must be reported to the United Network for Organ Sharing (UNOS) through a subcontract with the IPTR. Transplants performed outside the United States, however, are only reported on a volun- tary basis; the records, therefore, are incomplete. The following analysis is limited to transplants done in the United States between October 1, 1987 and July 31, 1997. Overall patient survival rates have continuously improved over the years (based on comparisons among 1987 to 1989, 1990 to 1991, 1992 to 1993, and 1994 to 1997). By recipient category, 1-year patient survival with a cadaver donor increased as follows: for simultaneous pancreas– kidney (SPK) recipients (n = 4,952), from 90% (1987 to 1989) to 94% (1994 to 1997) (P = .002); for pancreas after kidney (PAK) recipients (n = 446), from 90% to 95% (P = not significant [NS]). For pancreas transplant alone (PTA) recipients (n = 259), 1-year patient survival has remained at 93%. Similarly, overall graft survival rates have significantly increased over time. One-year pancreas graft survival for SPK recipients (n = 4,952) with cadaver donors increased from 74% (1987 to 1989) to 82% (1994 to 1997) (P = .0001); 1-year kidney graft survival increased from 86% to 89% (P = .004). For technically successful SPK transplants with a cadaver donor (n = 4,361), the number of pancreas graft losses due to rejection at one year decreased from 6% to 2% (P = .0001). For PAK recipients with a cadaver donor (n = 446), 1-year pancreas graft survival increased from 56% to 70% (P  .008). For technically successful PAK transplants with a cadaver donor (n = 331), the number of graft losses due to rejection at 1 year decreased from 25% to 10% (P  .01). For PTA recipients (n = 259), 1-year graft survival increased from 46% to 74% (P  .0001). For technically successful PTA transplants with a cadaver donor (n = 192), the number of graft losses due to rejection at 1 year decreased from 38% to 7% (P  .01). By recipient category, pancreas graft survival remains signifi- cantly higher for SPK recipients. Between January 1, 1994 and July 31, 1997, 1-year graft survival was as follows: SPK, 82%; PAK, 70%; and PTA, 74% (P = .0001). As with primary transplants, 1-year graft survival has improved for retransplant recipients over time: from 54% (1987 to 1989) to 67% (1994 to 1997). Although the most common technique for managing pancreas exocrine secretions has been bladder drainage (BD), interest in enteric drainage (ED) was revived in 1995. Before 1995, only 3% (1989) to 6% (1994) of all pancreas transplants used ED; in 1995, the percentage increased to 16%; in 1996, to 31%. Similarly, the number of pancreas transplant centers using ED increased from 4 (1988) to 14 (1994) to 19 (1995) to 33 (1996). With both BD and ED, 1-year graft survival for SPK recipients has significantly increased over time: from 75% (BD) and 29% (ED) (1987 to 1989) to 83% (BD) and 79% (1994 to 1997) (P = .0001 [BD] and P = .001 [ED]). With ED, results were slightly better for SPK recipients when a Roux-en-Y loop was used: between January 1, 1994 and July 31, 1997, 1-year graft survival with BD (n = 1,898) was 83%; with ED with Roux-en-Y (n = 192), 80%; with ED without Roux-en-Y (n = 226), 77% (overall P  .1). The difference was not significant for BD versus ED with Roux-en-Y (P = .35) or for ED with versus without Roux-en-Y (P = .36). But the difference was significant for BD versus ED without Roux- en-Y (P = .01). For SPK recipients, 1-year kidney graft survival was not different for recipients with BD versus ED (89% each) (P = .8). With BD, the technical failure (eg, graft loss from thrombosis, infection, pancreatitis, leak, bleeding) rate has also decreased over time. By recipient category, the tech- nical failure rate decreased as follows: for SPK recipients, from 16% (1987 to 1989) to 7% (1994 to 1997) (P = .001); for PAK recipients, from 16% to 13% (P = .006); for PTA recipients, from 18% to 10% (P = .29). Of all causes of technical failure, graft thrombosis has remained the most common. For the years 1994 to 1997, the incidence of graft From the Department of Surgery (A.C.G., D.E.R.S., R.W.G.S.), University of Minnesota, Minneapolis, Minnesota. Address reprint requests to Dr Angelika C. Gruessner, Univer- sity of Minnesota, Department of Surgery, 420 Delaware St. S.E., Minneapolis, MN 55455. 0041-1345/98/$19.00 © 1998 by Elsevier Science Inc. PII S0041-1345(97)01242-6 655 Avenue of the Americas, New York, NY 10010 242 Transplantation Proceedings, 30, 242–243 (1998)