Objective

Although pancreas transplantation is generally performed with donors in less-than-ideal condition in Japan, such as over 40% of donors being over 45 years of age because of severe shortages of donor, the rates of pancreatic graft survival remain relatively high at 87.0%, 81.4% and 76.7% at 1, 3 and 5 years after transplantation, respectively. The aim of this study was to establish marginal donor criteria for Japanese donors.

Methods

Study 1: A total of 281 pancreas transplantations in Japan were retrospectively analyzed in terms of the relationships of between the donor's condition and the graft survival.

Study 2: A total of 49 pancreas transplantations performed in our facility were retrospectively analyzed in terms of the relationships of between the donor's condition and the insulin secretion as evaluated by a glucagon tolerance test.

Results

Result 1: A higher donor HbA1c was associated with a significantly lower pancreatic graft survival in both univariate and multivariate analyses using Cox proportional hazards regression (hazard ratio, 1.92; p=0.028). The pancreatic graft survival with a donor HbA1c >6.0% dropped significantly to <50% at 3 years after transplantation. Other donor factors did not affect the pancreatic graft survival.

Result 2: For cases with a donor age of ≥50 years (p=0.005), a history of cerebrovascular accident (p<0.001), HbA1c ≥5.6% (p=0.023), CRP ≥25 mg/dl (p=0.003), Cre ≥1.5 mg/dl (p=0.011) and/or Na ≥150 mmol/l (p=0.02) at the time of procurement, the [Delta]CPR induced by the glucagon tolerance test was significantly lower than in other cases, suggesting the deterioration of insulin secretion.

Conclusion

Donors for pancreas transplantation should be carefully vetted when several factors are observed, especially more than four factors, including a donor age of ≥50 years, a history of cerebrovascular accident, HbA1c ≥5.6%, CRP ≥25 mg/dl, Cre ≥1.5 mg/dl and Na ≥150 mmol/l at the time of procurement in order to ensure good insulin secretion.

CITATION INFORMATION: Ito T., Kenmochi T., Kurihara K., Aida N. A Study to Identify Marginal Factors for Donors of Pancreas Transplantation in Japan Am J Transplant. 2017;17 (suppl 3).

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