Expanded criteria donors in pancreas transplantation
Brockmann J., Muthusamy A., Sinah S., Vaidya A., Friend P.
Introduction: Increasing pancreas transplant activity in the last few years has exposed the shortage of 'standard donors' for transplantation. In an effort to increase the potential donor pool, we liberalized our criteria for acceptance of pancreases. The graft and patient outcomes from such pancreas transplants are compared with the standard cohort. Methods: From April 2004 to April 2009, 265 pancreas grafts were procured either from 176 Standard Criteria donors (SCD) (donors after brainstem death (DBD) age 13-45) or 89 expanded criteria donors (ECD) including DBD (<12 or >45 years) & grafts from donors after cardiac death (DCD) (n=28). All grafts were implanted intraperitoneally with enteric exocrine and systemic venous drainage. Outcome measures were incidence of delayed graft function (DGF) of pancreas & kidney, graft & patient survival. Results: There were 265 transplants (261 recipients) with majority (n=249) receiving Campath induction with Tacrolimus/ MMF maintenance. There were 137 SPK, 24 PAK & 15 PTA from SCD and 58 SPK, 16 PAK & 15 PTA from ECD. SC donors had longer median follow-up (23 months vs. 16, p=-.004). EC donors had higher incidence of vascular cause of death (66% vs. 3%, p=0.0006) and lower incidence of head trauma (16% vs. 30%, p=0.01). SCD recipients were younger (42±7 vs. 46±8, p=0.0001) and had a lower BMI (24±4 vs. 26±4, p=0.03). ECD recipients had more readmissions (33% vs. 20%, p=0.03). Median cold ischemia, HLA mismatch, hospital stay, rejection incidence and reoperation rate for both groups were similar. ECD recipients more frequently had DGF of the kidney (19% vs. 11%, p=0.13) and of the pancreas (1.7% vs. 6.7%, p=0.06). Both groups had similar primary non-function rates (<1%). Overall patient survival (95 vs. 95.5%) and pancreas survival (SCD 92% vs. ECD 90%) was similar. Conclusions: Expanded criteria donors (defined by extremes of age and donors after cardiac death) provide comparable outcomes following pancreas transplantation. This data suggests re-visiting the definition of the 'expanded criteria' to make more pancreases available for transplantation.