Background: The use of DCD pancreata are gaining popularity in the UK. Isolated pancreas transplantation (IP) is known to have inferior outcomes in comparison to SPK. This abstract summarizes a large single centre experience with transplanting pancreases from controlled DCD (Maastricht III).

Methods: Our pancreas transplant database was interrogated to obtain data on 691 pancreas transplants from 2004 to 2014. DCD pancreata were accepted from 2007, based on donor age 60 years, BMI <30, and time to cardiac arrest from withdrawal <1 hour. Depleting antibody induction and steroid free maintenance was utilized.

Results: 43 SPK-DCD, 47 IP-DCD, 488 SPK-DBD and 113 IP-DBD were identified, resulting in significantly more IP from DCD (p=0.0001). DCD donors were younger (33±12y vs. 37±14y, P=0.01), had less vascular cause of death (35% vs. 59%, p<0.0001) and longer cold ischaemia (701±151min vs. 663±156min, p=0.02). DCD grafts had more graft thrombosis leading to early graft loss (8% vs. 1%, p<0.001) despite more frequent use of therapeutic anticoagulation (16% vs. 7%, p=0.008); IP-DCD graft thrombosis required pancreatectomy more frequently (vs. IP-DBD, p=0.02 vs. SPK-DCD, p=0.02).

In IP-DCD, thrombosis was predictive of the need for pancreatectomy (p=0.001) and DGF (requiring insulin at discharge) (p=0.015), which in turn predicted graft failure (p=0.05). DCD grafts were also lost to pancreatitis (6%) and/or to rejection (9%). SPK-DCD kidneys had more frequent delayed graft function (DGF) than SPK-DBD (34% vs. 16%, p=0.02). DCD pancreata tended towards more frequent DGF than DBD (8% vs. 3%, p=0.06). PNF incidence of the kidney and of the pancreas was similar. DBD pancreas grafts had better survival (79% vs. 71%, p=0.01) although graft survival of SPK and IP sub-groups was similar (82% SPK-DBD vs. 86% SPK-DCD, p=0.8; IP-DBD 70% vs. IP-DCD 57%, p=0.2). Overall patient survival was similar (93% DCD vs. 97% DBD, p=0.8).

Conclusion: Excellent SPK-DCD results suggest that this cohort is a good additional source to expand the donor pool. IP-DCD pancreata are more at risk of thrombosis related graft loss requiring explantation. IP-DCD grafts remain a feasible source for pancreases with comparable long-term survival, despite early graft loss risk. Clearly a multipronged strategy is required to improve graft utilization, encompassing donor management, preservation and recipient conditioning.

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