Sohail KHAN, Deric TORO, Sophia GONZALEZ, Dayanna ZULUAGA, Gavin MCAFEE, Giovanni FADDOUL, Naoru KOIZUMI, Meng-Hao LI, Hannah COHEN, Jorge ORTIZ
Experimental and Clinical Transplantation - 2026;24(6):481-491
Objectives: Historical registry analyses have reported inferior outcomes and higher early technical failure rates following pancreas-only retransplant after simultaneous pancreas-kidney transplantation, contributing to cautious utilization. Implementation of standardized pancreas graft failure definitions permits contemporary national reassessment of these outcomes. Materials and Methods: National registry data were extracted to evaluate 7966 adult recipients undergoing primary simultaneous pancreas-kidney transplantation (n = 7895) or pancreas-only retransplant with preserved kidney allograft function (n = 71) between February 2018 and December 2024. Multivariable regression and Cox proportional hazards models assessed pancreas graft failure and mortality. Results: Among 7966 adult simultaneous pancreas-kidney transplant recipients (7895 primary; 71 pancreas-only retransplant) from 2018 through 2024, retransplant recipients were older (71.8% vs 54.8% aged 40-59 years; P = .007), more frequently White (70.4% vs 46.9%; P = .003), had longer waiting times (627.9 vs 321.5 days; P < .001), longer pancreas preservation time (12.6 vs 10.4 hours; P < .001), and were more often transplanted at high-volume centers (69.0% vs 47.9% at centers with >100 simultaneous pancreas-kidney transplants; P < .001). Retransplant was not independently associated with pancreas graft failure or mortality at 1 year or 3 years. In Cox models, retransplant was not associated with pancreas graft failure (hazard ratio 0.84; P = .683) or mortality (hazard ratio 1.19; P = .544). Increasing recipient age and national sharing independently predicted mortality. Conclusions: In the contemporary era of standardized pancreas graft failure reporting, pancreas retransplant with preserved kidney function achieves graft and patient survival comparable to primary simultaneous pancreas-kidney transplant nationally. Although retransplant recipients represent a small and highly selected cohort, these population-level data reinforce selective retransplant consideration at experienced centers following pancreas allograft failure.
