Post-Donation Outcomes in 46 Live Pancreas Donors

V. Kirchner, D. Sutherland, T. Dunn, E. Finger, T. Pruett, R. Kandaswamy.

Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN.

Meeting: 2015 American Transplant Congress

Abstract number: 11

Keywords: Donation, Outcome, Pancreas transplantation

Session Information

Session Name: Concurrent Session: Controversies in Pancreas Transplantation

Session Type: Concurrent Session

Date: Sunday, May 3, 2015

Session Time: 2:15pm-3:45pm

Presentation Time: 3:15pm-3:27pm

Location: Room 122-AB

Background: Live donor segmental pancreas transplants have been performed selectively to increase the pool of donors, minimize cold ischemia time, and to avoid brain death. Post-donation outcomes among live pancreas donors have not been well studied.

Methods: Between 1/1/1994 and 5/1/2013, 37 LR and 9 LUR partial pancreas transplants (40 SPK, 2 PAK, 4 PA) (7 laparoscopic, 39 open) were performed with median follow-up of 12 years (0-18 years). Post-donation complications, pre- and post-donation BMI, glycemic control, HTN, hyperlipidemia and cardiovascular disease were studied. Pancreas graft survival and causes of graft loss are reported.

Average donor age was 42.8 (+/- 9.7) years old (39% male, 91% Caucasian). Eight donors were lost to follow-up (>4 yrs); 38 donors were alive at the time of the last follow-up.

Results: Pre- and post-donation glucoses and BMIs were 90+/-19 mg/dL and 25+/-3.7 kg/m²; and 110+/-36 mg/dL and 25.7+/-3.2 kg/m². Post-donation outcomes are shown in Table 1.

Table 1: Post-Donation Outcomes (n=46)
		Number of Events
Intraoperative:
	Splenectomy	5 (11%)
	Transfusion (1-5 units)	4 (9%)
	Transfusion (6-10 units)	1 (2%)
Postoperative:
	Pseudocyst	6 (13%)
	Pancreatitis	2 (4%)
	Splenic infarct (requiring splenectomy)	4 (9%)
New Diagnosis:
	Hyperglycemia requiring oral hypoglycemics/dietary control	7 (15%)
	Hyperglycemia requiring insulin	5 (11%)
	Hyperlipidemia	13 (28%)
	HTN	10 (22%)
	Cardiovascular disease	6 (13%)

Post-donation hyperglycemia was diagnosed in 12 donors, 5 of whom required insulin and 7 required oral hypoglycemics and dietary management. Average time to onset of hyperglycemia was 7.9 (+/-5) years post-donation.

Mean graft survival was 8.3 (+/-5.4) years; death censored graft survival was 91%, 73%, 50% at 1, 5 10 years post-transplant. At the time of last follow-up, 24 (55%) grafts failed (Table 2).

Table 2: Causes of Graft Failure (n = 24)
Chronic Rejection	46% (12)
Unknown	23% (6)
Graft Thrombosis	12% (3)
Graft Malignancy	4% (1)
Pancreatitis	4% (1)
Acute Rejection	4% (1)

Conclusions: Segmental live pancreas donation is associated with significant surgical complications including splenectomy, pseudocyst formation and metabolic complications including post-donation hyperglycemia. Careful surgical and metabolic screening could potentially improve these outcomes. Recipient outcomes however are comparable to historical DD outcomes despite a higher graft thrombosis rate.

To cite this abstract in AMA style:

Kirchner V, Sutherland D, Dunn T, Finger E, Pruett T, Kandaswamy R. Post-Donation Outcomes in 46 Live Pancreas Donors [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/post-donation-outcomes-in-46-live-pancreas-donors/. Accessed November 21, 2024.

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