Proposed changes in pancreas transplant (PT) allocation may improve organ sharing but increase cold ischemia time (CIT). Methods: We performed a single center, retrospective study of 202 consecutive PTs in 192 patients and analyzed outcomes according to donor site of origin and CIT. All patients received either rATG or alemtuzumab induction with tacrolimus, MMF, and tapered steroids. Results: From 11/01 to 3/13, we performed 162 simultaneous kidney-PTs (SKPT) and 40 solitary PTs; 160 were local and 42 were import organs. Solitary PT recipients were more likely to receive an import organ (47% solitary vs 14% SKPT, p<0.001). 37 PTs were performed with pancreas CITs ≥20 hours (mean CIT 21.8 hours) whereas the remaining 165 PTs had CITs <20 hours (mean CIT 14.9 hours, p<0.001). There were no other differences between the study groups except that import organs came from younger donors (mean import 23 vs local 27 yrs, p=0.04) with longer pancreas CITs (mean import 17.3 vs local 15.6 hrs, p=0.02). With a mean follow-up of 7 years, actual patient survival (78.4% ≥20 vs 85.8% <20, p=0.31), kidney (51.5% ≥20 vs 78.3% <20, p=0.004) and pancreas graft (PG, 45.9% ≥20 vs 64.2% <20, p=0.04) survival rates were inferior in PTs with prolonged CITs. Death-censored kidney and PG survival rates were 63% ≥20 vs 86.3% <20 and 51.5% ≥20 vs 75% <20 (both p=0.01), respectively. The early (3 month) relaparotomy rate was 56.8% ≥20 vs 32.7% <20 (p=0.008) including an early PT thrombosis rate of 13.5% ≥20 vs 6.7% <20 (RR=2.0, p=0.18). One- and 5-year actuarial kidney graft (import 95%/83% vs local 97%/80%), PG (import 83%/58% vs local 87%/72%), and patient survival (import 98%/89% vs local 97%/92%, all p=NS) rates were comparable between recipients of import and local organs. PG survival was significantly worse in SKPT recipients from import donors (1- and 5-year PG survival for imports was 78%/45% vs local 87%/73%, p=0.013) and was related to longer CIT. Technical and non-technical causes of PG failure were similar with import and local donors. Conclusions: Prolonged pancreas CIT is associated with inferior graft survival rates. We observed that PG survival was inferior in SKPT recipients from import donors despite similar causes of PG loss with import and local organs. Strategies to decrease CIT should be deployed for improving utilization and outcomes.

CITATION INFORMATION: Khan M, El-Hennawy H, Rogers J, Farney A, Orlando G, Reeves-Daniel A, Palanisamy A, Stratta R. Influence of Pancreas Import and Cold Ischemia on Outcomes Following Pancreas Transplantation. Am J Transplant. 2016;16 (suppl 3).

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