A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

Abstract

Surgical injury to the pancreas is thought to occur commonly during procurement. The UK Transplant Registry was analyzed to determine the frequency of pancreatic injuries, identify factors associated with damage, and assess the impact of injuries on graft survival. Twelve hundred ninety-six pancreata were procured from donation after brain death donors, with 314 (19.5%) from donation after circulatory death donors. More than 50% of recovered pancreata had at least one injury, most commonly a short portal vein (21.5%). Liver donation, procurement team origin, hepatic artery (HA) arising from the superior mesenteric artery (SMA), and increasing donor BMI were associated with increased rates of pancreas damage on univariate analyses; on multivariate analysis only the presence of an HA from the SMA remained significant (p ¼ 0.02). Six hundred forty solid organ pancreas transplants were performed; 238 had some form of damage. Overall, there was no difference in graft survival between damaged and undamaged organs (p ¼ 0.28); however, graft loss was significantly more frequent in pancreata with arterial damage (p ¼ 0.04) and in those with parenchymal damage (p ¼ 0.05). Damage to the pancreas during organ recovery is more common than other organs, and meticulous surgical technique and awareness of damage risk factors are essential to reduce rates of procurement-related injuries.

Rotational culture and integration with amniotic stem cells reduce porcine islet immunoreactivity in vitro and slow xeno‐rejection in a murine model of islet transplantation

“…The use of bioreactor technology to co‐localize cells across species barriers is novel and has important therapeutic implications. The limited availability of human cadaveric material is circumvented by use of porcine tissue, which is proposed to become a feasible source for human implantation following adoption of CRISPR‐based gene editing to inactivate porcine endogenous retroviruses . The incorporation of AEC to porcine islet grafts adds localized anti‐inflammatory and immunomodulatory properties that reduce xenogenicity.…”

High alcohol intake in deceased donors has no effect on pancreas graft survival: a registry analysis

“…Previous work has shown that a high proportion of pancreases that are offered for allocation are not transplanted, often due to perceived unfavorable donor characteristics (e.g., age, BMI, elevated serum amylase) or the appearance or consistency of the pancreas at the time of recovery of organs or bench work . Furthermore, the pancreas is more vulnerable to intraoperative injury than other abdominal organs during recovery of organs . As a result, the conversion rate from potential pancreas donor to implantation in a recipient is low; registry data show that only 70% of potential donor pancreases offered for donation are recovered, and of these, a further 30–50% are discarded after recovery of organs has been completed .…”

Influence of the procurement surgeon on transplanted abdominal organ outcomes: An SRTR analysis to evaluate regional organ procurement collaboration

“…for pancreas, 34 but the rate of discard resulting from surgical injury for these organs is 0.8-1.4% for kidney, 32,35 .8-6.6% for liver, 33,35 and 10-13% for pancreas. 35,36 Thus, these data indicate that albeit common, procurement-related injury is rarely irremediable or transplant-defining.…”