Equivalent graft outcomes between donation after brain death (DBD) and donation after cardiac death (DCD) pancreas transplant

T. Jie, A. Gruessner, C. Desai, K. Khan, H. Rilo, R. Gruessner
University of Arizona, Surgery, Tucson, USA

DCD pancreas allograft was underutilized because the concerns of technical complications, detrimental effects of prolonged warm ischemic injury, increased risks of developing graft pancreatitis and poor long-term graft outcomes. A retrospective database (IPTR) review was performed in three categories of pancreas transplant: pancreas transplant alone (PTA), pancreas after kidney transplant (PAK), or simultaneous pancreas and kidney transplant (SPK) between 2000 and 2009. 1.73% (n=225) of the pancreas grafts were from DCD among 12,983 pancreas transplant performed. The DCD graft utilization increased from 0.38% in 2000 to 3.43% in 2009. The categories of pancreas transplants from DBD and DCD were shown. The recipient age, gender, BMI, wait time, PRA, HLA mismatch; and donor age, gender, causes of death, BMI, and cold ischemic time were found not to be significantly different between DBD and DCD pancreas transplants. In addition, we compared centers that performed more than 20 pancreas transplants per year for last 5 years (high volume) to others. High volume centers were found to have 2.2-folds increased likelihood of utilization DCD pancreas (odds ratio 2.216, 95% confidence limits between 1.641 and 2.991). Furthermore, high volume centers also performed proportionally more primary PTA (66%), vs. PAK (35%) and SPK (38%) when compared to other centers (p-value 0.0001). Importantly, the pancreas graft outcomes were similar between DBD and DCD pancreas transplant in all three categories (table 2). High volume pancreas transplant centers performed more primary PTA and had higher DCD utilization. With comparable long-term pancreas graft outcomes, pancreas transplant from DCD graft should be seriously considered.