Diabetes Mellitus in Living Pancreas Donors

Abstract

Background Living donor pancreas transplant is a potential treatment for diabetic patients with end-organ complications. While early surgical risks of donation have been reported, long-term medical outcomes in living pancreas donors are not known. Methods We integrated national Scientific Registry of Transplant Recipients data (1987–2015) with records from a nationwide pharmacy claims warehouse (2005–2015) to examine prescriptions for diabetic medications and supplies as a measure of post-donation diabetes mellitus. To compare outcomes in controls with baseline good health, we matched living pancreas donors to living kidney donors (1:3) by demographic traits and year of donation. Results Among 73 pancreas donors in the study period, 45 were identified in the pharmacy database: 62% women, 84% white, and 80% relatives of the recipient. Over a mean postdonation follow-up period of 16.3 years, 26.7% of pancreas donors filled prescriptions for diabetes treatments, compared with 5.9% of kidney donors (odds ratio [OR] 4.13, 95% confidence interval [CI] 1.91–8.93; P = 0.0003). Use of insulin (11.1% vs. 0%) and oral agents (20.0% vs. 5.9%; OR 4.50, 95% CI 2.09–9.68; P = 0.0001) was also higher in pancreas donors. Conclusion Diabetes is more common after living pancreas donation than after living kidney donation, supporting clinical consequences from reduced endocrine reserve.

Landscape of Living Multiorgan Donation in the United States

“…23–27 Data on long-term outcomes are limited, but a recent study of 45 living pancreas donors that included 69% simultaneous kidney donations found that over a mean postdonation follow-up period of 16.3 years, 26.7% filled prescriptions for diabetes treatments, compared with 5.9% of kidney-alone living donors (odds ratio 4.13, 95% confidence interval 1.91–8.93; P = 0.0003). 28 These findings suggest a more than 4-fold increase in the incidence of diabetes following living kidney-pancreas donation, a concern that warrants longer follow-up and investigation to adequately understand risks to the donor.…”

Decreased α-cell mass and early structural alterations of the exocrine pancreas in patients with type 1 diabetes: An analysis based on the nPOD repository

“…However, the link between beta-cell mass and beta-cell function has been previously established in several studies in healthy living donors who had undergone hemipancreatectomy [ 28 – 30 ], all of them reporting a deterioration of insulin secretion and glucose tolerance in these subjects. This model is particularly relevant since individuals undergoing hemipancreatectomy exhibit a significant decrease in beta cell mass while beta-cell area to total pancreatic tissue ratio is conserved.…”