Session Time: 3:15pm-4:45pm
Presentation Time: 3:15pm-3:27pm
*Purpose: For 15 years pancreas transplantation (PT) numbers have paradoxically declined. We sought to understand the drop in all types of PT and to find potential growth options.
*Methods: A workgroup for the AST Kidney Pancreas Community of Practice created and conducted a survey of members of the AST and ASTS from 8/28/19 to 11/27/19.
*Results: The survey yielded 93 complete responses, 89 were from respondents within the US at 69 different pancreas transplant programs. Respondents were surgeons 71%, nephrologists 17%, trainees 9%, and allied professionals 3%.
The annual volume of PT performed at responding centers was 0 (4%), 3-5(14%), 6-10 (30%), 11-20 (35%), 21-30 (4%), and over 30 (8%). PT types were pancreas alone 89%, pancreas after kidney 94%, simultaneous pancreas kidney (SPK) for type 1 diabetes 99%, SPK for type 2 diabetes 79%, PT from donation after cardiac death 33%, and PT from Public Health Service increased risk donors 83%.
Factors the majority felt were important for increased PT at their center included: increased referrals, expansion of recipient selection, more aggressive donor utilization, and hiring of personnel specific to the pancreas program. Most respondents, 79%, felt their program was not responsive to their diabetic population in need, and 75% felt the number of PTs nationally was not in balance with the number of patients in need.
Reasons for declining a pancreas during a procurement were: firm or fatty infiltration 73%, edema 59%, and arterial anatomy 32%. Sixty-seven% of respondents have a protocol for periodic assessment of kidney alone candidates for SPK listing. The maximal acceptable BMI for type 1 diabetes candidates was 30-35kg/m2 (56%). Criteria for PT in type 2 diabetes patients were insulin dependence, BMI less than 30 (44%), or less than 35 (33%).
*Conclusions: Respondents reported that PT volume at both their center and nationally has fallen critically short. The survey results suggested that prioritizing PT, defining specific donor and recipient selection criteria, and education of a broader community of PCPs and endocrinologists are critical to increasing PT. A concerted effort from all the stakeholders is likely required to address the mismatch between current guidelines and the clinical needs of diabetic patients.
To cite this abstract in AMA style:Parsons RF, Alhamad T, Lentine KL, Basu A, Woodside KJ, Romeo G, Klein C, Pavlakis M, Friedewald J, Dadhania D, Cooper M. Survey on Solid Organ Pancreas Transplantation in the United States: Plenty of Insulin, Short on Procedures! [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/survey-on-solid-organ-pancreas-transplantation-in-the-united-states-plenty-of-insulin-short-on-procedures/. Accessed September 28, 2020.
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