INTRODUCTION: Pancreata are frequently not recovered or are discarded, resulting in a very low national utilization (~15%). There are many reasons why a transplant center might decline a pancreas offer from another OPO related to perceived donor quality based on demographics and labs, but absent information about actual gland quality. The relationship between position on the match run, indicative of number of centers who chose not to utilize a pancreas, and overall graft survival, is not well known.

METHODS: The study population consisted of all 199 isolated pancreas grafts transplanted at the University of Wisconsin-Madison since July 2000. Pancreas grafts were compared on overall graft survival based on import versus local status, controlling for donor and recipient characteristics. Overall survival was estimated by the Kaplan-Meier method, and factors associated with differential graft survival were measured in a Cox proportional hazards model.

RESULTS: 15/199 isolated pancreas transplants (7.5%) came from the local OPO. The median match rank from outside OPO was 49 (interquartile range 14-129). Median cold ischemia time was longer for imported pancreata (13.4 vs 16.7 hours, P = 0.01). Graft survival was not significantly associated with imported versus local pancreata (Figure, log rank P = 0.97). When comparing imported grafts with extreme rank positions of less than 25 versus greater than 100, there was no association with graft survival (P = 0.92). In a Cox proportional hazards model accounting for donor and recipient factors, there was also no association with position on the rank list, local pancreas source, and overall graft survival (P = 0.95).

CONCLUSIONS: In this single center study, there was no association with match run position and overall graft survival. Import offers for pancreata for solitary transplant that have been turned down by many other centers should be considered. While the logistics may be challenging, sound judgement to accept an offer that is independent of prior centers' decisions can result in quality utilization of imported pancreata.

CITATION INFORMATION: Adler J., Redfield R., Kaufman D., Odorico J. Isolated Pancreas Transplantation: Does Rank List Position Matter for Imported Grafts? Am J Transplant. 2017;17 (suppl 3).

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