Specialty: Transplant Surgery 

Keywords: surgical-equity, transplant, pancreas 

Background: Diabetes mellitus is a leading cause of ESRD in the US with Native Americans and Blacks showing the greatest increase in incidence of diabetes-related ESRD from 1988-1996, just under an 8% increase per year compared with only a 2.65% annualized increase for whites during the same period.1 Historically, pancreatic transplantation was limited to T1DM, but are now approved for selected T2DM cases. Striking racial disparities exist in the access to SPK transplantation for minorities with ESRD secondary to T1DM, yet no research on T2DM pancreatic transplants exists. 

Objective: Examine SPK, PTA, and PAK transplantation trends in the US, particularly those that relate to equity in access to transplantation. 

Methods: A retrospective study utilizing data by United Network for Organ from 2015 to 2022, following a review by Isaacs, et.al. of SPK transplantation data through 1996 that noted “striking” disparities in care based on patient race.1

Results: This study confirms continued, significant disparities between the prevalence of disease requiring transplantation and rates of transplantation based on race. Caucasians received over 52.4% of transplants while representing only 30.7% of diabetic Americans with ESRD. Blacks and Latinos represented 34.2% and 26.0% respectively of diabetic-related individuals with ESRD, yet only received 27.2 % and 15.7% of transplants.  

Conclusions: Differences in type of diabetes may reflect more equitable admission protocols for T2DM or stronger prevalence in these populations for T2DM compared to T1DM. Racial bias may still be an issue and conclusions require analysis with consideration of racial prevalences for T1DM and T2DM DM individually. Results of this study raise concerns that screening protocols for transplantation that give weight to demographics such as employment and access to post-operative care may result in inequitable organ allocation. Future studies should better assess the root causes of these disparities. 

Abbreviations: 

• T1DM: Type 1 Diabetes Mellitus 

• T2DM: Type 2 Diabetes Mellitus 

• ESRD: End-stage renal disease 

• SPK: Simultaneous pancreas and kidney transplant  

• PTA: Pancreas transplant alone 

• PAK: Pancreas after kidney transplant

References: [1] Isaacs, R. B., Lobo, P. I., Nock, S. L., Hanson, J. A., Ojo, A. O., & Pruett, T. L. (2000). Racial disparities in access to simultaneous pancreas-kidney transplantation in the United States. American journal of kidney diseases, 36(3), 526-533.