Five Decades of Pancreas Transplantation at the University Hospital of Zurich—A Story of Continuous Improvement and Success

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INTRODUCTION: Pancreas transplantation (PT) represents the gold standard in patients with type I diabetes mellitus (T1D) and end-stage kidney disease (ESKD). We aimed to describe the evolution of PT at the University Hospital of Zurich from 1973 to 2023, and to analyze differences in patient and graft survival within different eras of surgical technique. METHODS: This study represents a retrospective analysis of all primary PT performed at the University Hospital Zurich between 1973 and 2023. According to differences in surgical technique, we defined five different eras of PT. RESULTS: Overall, 280 primary PT were performed. Overall survival at 1, 5, and 10 years improved from 73.5%, 51%, 44.9% in Era 3, to 69.7%, 60.6%, 51.5% in Era 4, and 95.8%, 95.4%, 82.1% in Era 5, respectively (p < 0.001). Insulin-free survival after 1, 5, and 10 years was 34.5%, 25.5%, 16.4% in Era 3, 41.5%, 34.1%, 31.7% in Era 4, and reached 85.5%, 78%, 64.5% in Era 5 (p < 0.001), respectively. CONCLUSION: Enhanced surgical techniques and improvements in immunosuppression helped to overcome many obstacles that hampered the early days of PT, evolving PT into a safe and highly efficient procedure. PT represents the treatment of choice for patients with T1D and ESKD.

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