Background:

Pancreas transplantation in the U.S. has declined steadily in the U.S. over the past decade despite international growth of the practice. Reasons for this decline include better medical management of diabetes, inadequate appreciation of clinical benefits, and insurance barriers. Pancreas allografts procured from non-standard donors may be particularly vulnerable to discard. While use of donation after cardiac death (DCD) kidneys has increased remarkably in recent years, little is known about pancreas discard rates when a kidney from a DCD donor is used for transplantation.

Methods:

We performed a retrospective analysis of Organ Procurement and Transplantation Network (OPTN) records for DCD kidney transplants in the U.S. between 2000 and 2013. We examined pancreas discard rates from the same DCD donor if one kidney was transplanted. Pancreata that were declined for “DCD” as the specified reason were quantified. Pancreas donor risk index (PDRI), which includes 10 donor factors and preservation time, was calculated for the discarded pancreas grafts, with imputation of 14 hr for preservation time.

Results:

There were 13476 DCD kidney transplants from 7539 donors during the study period. Out of these donors, 4.1% pancreata were transplanted, 17.5% consent was not requested or obtained for pancreas donation, and 72.8% consent was obtained but organ was declined (not recovered or recovered but not transplanted). Out of the declined pancreata (n=3990), 27% due to DCD, 27% to poor organ function, 10% donor history, 4.5% time constraints and 31.5% not specified/others. The rate of pancreas discard attributable to DCD from these donors increased from 18% in 2000 to 26% in 2013. Median PDRI for the discarded pancreas grafts attributable to DCD was 1.61 (min=0.41, Q1=1.05, Q3=2.28, max=6.11).

Conclusion:

The rate of pancreas discard attributed to DCD has increased in recent years. This high discard rate has occurred despite excellent PDRI scores in 25% of discarded pancreata which predict good clinical outcomes. Better utilization of PDRI and facilitated placement might improve utilization of pancreas allografts from DCD donors for patients who can benefit.

CITATION INFORMATION: Alhamad T, Lentine K, Taha A, Wellen J, Brennan D. What Is the Decline Rate of Pancreata Attributed to Donation After Cardiac Death When the Accompanied Kidney Is Transplanted? Am J Transplant. 2016;16 (suppl 3).

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