Criteria for organ acceptance remain inconsistent in pancreatic transplantation. The lack of predictive criteria limits the ability to standardize critical care practices in management of donors after neurologic determination of death. We examined predictors of pancreatic graft use and survival to better guide selection and management of potential organ donors. A prospective, observational study of all standard criteria donors managed by ten organ procurement organizations (OPOs) was conducted from 2013 to 2015. Nine critical care end points, or donor management goals (DMGs), reflecting normal hemodynamic, acid−base, respiratory, endocrine, and renal parameters in the donor were collected at 4 time points: (1) referral to the OPO, (2) authorization for donation, (3) 12-18 hours after authorization, and (4) prior to organ recovery. The DMG Bundle was considered “met” if any 7 of the 9 endpoints were achieved. Donor demographic and medication data were also collected, including dosages of insulin and vasopressors. Critical care and demographic data associated with pancreatic transplantation and graft survival rates were determined using univariate analyses, followed by identification of independent predictors using stepwise logistic regression and Cox proportional hazards models. From 1819 donors, 238 (13%) pancreata were transplanted and 202 (84%) were functioning after 191 +/- 156 days. On stepwise regression, age, BMI, glucose prior to organ recovery, PaO2:FiO2 ratio at authorization, urine output at 12-18 hours after authorization, and hemoglobin A1C were independent predictors of pancreas utilzation. Using Cox proportional hazards models, age, mean arterial blood pressure at referral, glucose prior to organ recovery, and the DMG bundle being met prior to organ recovery were shown to be independent predictors of graft survival. For pancreas transplantation, lower deceased donor age, BMI, and hemoglobin A1C, as well as achieving normal values for glucose, oxygenation, and urine output were predictive of increased graft use. Lower donor age, a normal glucose level prior to organ recovery, and the DMG bundle being met prior to organ recovery were independent predictors of pancreas graft survival. Donor insulin dosages did not predict pancreas graft acceptance or survival. These results may help guide the management and selection of potential pancreatic donors after neurologic determination of death.

CITATION INFORMATION: Sally M, Ellis M, Groat T, Gao X, De la Cruz S, Patel M, Malinoski D. Deceased Organ Donor Factors Influencing Pancreatic Graft Transplantation and Survival. Am J Transplant. 2016;16 (suppl 3).

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