Donor Hyperglycemia as a Minor Risk Factor and Immunologie Variables as Major Risk Factors for Pancreas Allograft Loss in a Multivariate Analysis of a Single Institutionʼs Experience

Abstract

The impact of multiple donor and recipient variables on functional survival of 307 cadaveric pancreas allografts transplanted in 253 recipients at the authors' institution between July 25, 1978 and September 4, 1990 was determined using the Cox proportional hazards regression model. Relative risk of graft loss was calculated for all cases as well as for technically successful (TS) ones. Factors with an impact in descending order of significance for TS cases were immunosuppression (RR = 3.9 for double-drug versus triple-drug maintenance, p less than 0.0001); recipient category (RR = 2.4 for pancreas alone versus simultaneous pancreas/kidney, p = 0.009); retransplantation (RR = 1.8 for retransplants versus primary grafts, p = 0.007); donor hyperglycemia (RR = 1.7 for blood glucose greater than or equal to 200 versus less than 200 mg/dL, p = 0.02); human leukocyte antigen (HLA) matching (RR = 2.1 for poor versus a good match, p = 0.04). A logistic regression analysis also was performed to determine which factors predisposed to technical failure; none were identified. To make the model as relevant as possible to their current program, the authors analyzed only the bladder-drained cases (n = 221; 1984 to 1990). All patients received triple therapy. Recipient category, retransplantation, donor hyperglycemia, and degree of HLA matching remained as significant risk factors. Construction of estimated survival curves showed that the results of retransplantation were significantly improved, and the penalty incurred by using hyperglycemic donors was partially ameliorated by using well-matched donors. Because preservation times up to 30 hours did not exert an adverse effect on outcome, an argument is made to share pancreata between centers to achieve good matches.

HLA-A, -B, -C, -DR, and -DQ Matching in Pancreas Transplantation: Effect on Graft Rejection and Survival

“…But for pancreas recipients, the effect is not as clearly defined. Early studies showed an increased rate of graft loss with a higher number of HLA MMs, at least at the HLA-A, -B, or -DR loci (16,17). Yet, more contemporary analyses do not support those early findings.…”

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

“…254 Although pancreas grafts from both pediatric 262 and older donors 263 have been successfully transplanted, 107 we 107 and others 264,265 are selective. Whatever the age range, one group has shown that the outcomes for paired grafts from the same donor are similar in KTA and SPK recipients.…”

Kidney-Pancreas Transplantation

“…Absolute contraindications for pancreas donation are active infection or malignancy, positive serologic evaluation for hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and human T cell lymphotropic virus type 1 (HTLV-1), proved diabetes mellitus, pancreatitis (acute/chronic), severe pancreatic steatosis or edema, previous pancreatic surgery and intra-abdominal sepsis. Donor hyperglycemia is common because of stress condition and use of high dose corticosteroids and not a contraindication for use of the pancreas, although it may contribute as a minor risk factor for long-term graft loss (Gores, et al, 1992). Most surgeons only select younger non-obese donors (age 10-50 years, weight 30-100 kg) who are hemodynamically stable without need to high doses of vasopressors.…”