Present status of pancreas transplantation from deceased donors in Japan

T. Kenmochi¹, T Ito², M Ishibashi^3
1 Chiba-East National Hospital, Clinical Research Center, Chiba City, Japan; ² Osaka University, Osaka City, Japan; ³ Nara Medical University, Kashihara City, Japan

Registry Committee of the Japan Society for Pancreas and Islet Transplantation.

Since the Organ Transplant Law was enforced in 1997, 108 pancreas transplantations(PTx) [84; from brain dead donors(BDD), 2; non heart beating donors(NHBD), 22; from living donors(LD)] were performed from 2000 to 2010 in Japan. Especially in 2010, 25 PTxs were performed because of the amendment of the Law on 17th July. In this study, we evaluated the effectiveness of 86 PTxs from deceased donors by analyzing the data both of the donor and the recipient. Fifty-four donors (63%) were over 40 years, which was older as compared to the US and Europe. The Cause of death was cerebrovascular diseases in 49 donors (57%). According to the criteria by Kapur, 66 donors (76.7%) in our series were considered to be marginal donors. For the safe use of marginal pancreas, we reconstruct the blood vessels of the graft using donor Y-graft or I-graft before transplantation. Category of PTxs were SPK; 72 (83.7%), PAK; 10 (11.6%) and PAK; 4 (4.7%). The duration of insulin therapy and hemodialysis of the recipients were 24.6 and 6.5 years. Waiting period was 1,274 days (Mean). Induction therapy by @IL-2R or ATG was performed in 81 patients (94%) and immunosuppression was maintained by tacrolimus (96.5%) or cyclosporin (3.5%) combined with MMF and steroid. Enteric drainage was selected in 67 patients (78%) and bladder drainage in 19 patients (22%). 5-year recipient survival was 95.9%. Pancreas graft survivals were 86.8% at 1-year, 81.4% at 3-year and 71.6% at 5-year. While, kidney graft survivals were 92.6% at 1- and 3-year, and 84.0% at 5-year, respectively. Although majority of the deceased donors were marginal in our country, clinical outcome of PTxs demonstrated that PTx was a potent and promising treatment for severe type 1 diabetic patients also in Japan.