Shifting Pancreas Transplantation Rates and Demographics are the Culmination of Many Strategic Policy Changes

The 2014 Pancreas Allocation System established national qualifying criteria for simultaneous kidney pancreas (SPK) transplantation. The 2019 UNOS Pancreas Transplantation Committee Policy 11.3.B modified these guidelines to expand transplantation. Subsequent effects on recipient demographics have not been studied. We analyzed 81 SPK transplantations performed at our center from June 2014 to December 2020 to compare recipient demographics and outcomes before and after the 11.3.B policy change. National data were also investigated. Significant increases in age (38.9 v 46.4 years; p = 0.01) and c-peptide levels (1.7 v 4.9 ng/ml; p = 0.01) occurred following the removal of BMI and c-peptide requirements. No differences in BMI, outcomes, or complication rates were found. National and center trends showed increasing numbers of recipients with high c-peptide levels and decreasing numbers of recipients with undetectable c-peptide levels. Policy 11.3.B expanded transplantation access while maintaining suitable outcomes, reflecting its intended goals.