Introduction: Brain stem death causes high levels of systemic catecholamines and inflammation affecting all organs. These changes, and the routine use of high-dose corticosteroids in intensive care units (ICU), contribute to hyperglycaemia which is managed with insulin in about half of all donors. We hypothesised that donor insulin use (DIU) is a marker of irreversible pancreatic beta-cell death. We aimed to assess relationships of DIU to pancreas transplant outcome and function.

Methods: National data from the UK Transplant registry (2004-2016) was reviewed retrospectively to determine donor variables associated with DIU and its relationship with graft survival. Early non-technical graft failure (transplant pancreatitis) was assessed from histology reports using our regional data (2010-2015). In a sub-group, we determined relationships between DIU and early c-peptide secretion.

Results: In 1943 pancreas transplant donors nationally, 1005 (52%) required insulin. Insulin-treated donors were older (p=0.016), female (p<0.0001), DBDs (p<0.0001), hypotensive (p=0.004) and more likely to die from meningitis (p=0.0001). Donors not treated with insulin were more likely to die from hypoxic brain damage (p=0.005) or trauma (p=0.002), and were more likely to have suffered cardiac arrest (p=0.015). There was no difference in graft survival (median follow-up: 3 years) by DIU: donor variable-adjusted HR (95%CI), insulin vs no insulin: 0.93 (0.76-1.14), p=0.684; donor and recipient variable-adjusted HR 1.0, (0.77-1.29), p= 0.978. Early pancreas graft loss due to non-technical failure was more commonly associated with DIU (proportion failing: with vs. without insulin: 6/72 (8.3%) vs 1/96 (1%) p=0.02). In a sub-group (n=46), pancreas graft function 72-hours post-transplant was lower in donors requiring insulin (c-peptide levels in insulin vs no insulin donors: 4.3 vs. 7.5 ng/mL, p<0.001).

Discussion: DIU could be a useful clinical predictor of early pancreas graft outcome and function. Further understanding of the physiological processes causing hyperglycaemia in donors could improve donor selection and lead to better outcomes.

CITATION INFORMATION: Shapey I, Khambalia H, Summers A, Augustine T, Rutter M, van Dellen D. Insulin Therapy in Pancreas Donors as a Predictor of Subsequent Transplant Outcome. Am J Transplant. 2017;17 (suppl 3).

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