Donor risk factors in pancreas transplantation

Muñoz‐Bellvís, Luís; López-Sánchez, Jaime

doi:10.5500/wjt.v10.i12.372

Cited by 5 publications

(7 citation statements)

References 39 publications

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“…The cutoff value for donor age was set to 50 years, which is often discussed as a marginal donor criterion for pancreas transplantation with graft survival as an outcome. [11][12][13]15 It was revealed that pancreatic grafts from donors 50 years or older were shown to have a poorer endocrine function in comparison with those from younger donors in this study. In addition to having a negative impact on pancreatic graft survival, 14 donation from older donors and donors who have died of CVA is associated with the possibility of atherosclerosis, which may result in reduced insulin secretion ability.…”

Section: Discussionmentioning

confidence: 94%

“…These extended criteria have been reported by several authors. [8][9][10][11][12][13][14] We examined the correlation between these risk factors and pancreatic graft survival; however, it has been shown that donor age and ischemic time do not affect pancreatic graft survival in Japan. Therefore, as a donor evaluation, we focused on the endocrine function after pancreas transplantation.…”

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confidence: 99%

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An Examination of Donor Factors That Impact the Results of the Glucagon Stimulation Test as an Assessment of the Pancreatic Graft Endocrine Function

et al. 2022

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ObjectivesDelta C-peptide derived by the glucagon stimulation test is a reliable value for the evaluation of the pancreatic endocrine function after pancreas transplantation. We examined the associations between delta C-peptide as pancreatic graft endocrine function and donor background factors.MethodsSixty-five cases of pancreatic transplantation from brain-dead donors, which were performed in our facility, were enrolled in this study. Enrolled recipients underwent a glucagon stimulation test within 1 to 3 months after transplantation to evaluate the pancreatic graft endocrine function with delta C-peptide to compare donor background factors.ResultsThe following factors were associated with significant deterioration of the delta C-peptide: age of 50 years or greater, death from cerebrovascular accident, hemoglobin A1c level of 5.6% or greater, creatinine level of 1.0 mg/dL or greater, C-reactive protein level of 25 mg/dL or greater, and sodium level of 150 mmol/L or greater. In addition, increased numbers of these donor factors indicated significantly greater deterioration of the posttransplant pancreatic endocrine function (P < 0.001).ConclusionsTo secure insulin independence after pancreas transplantation, which means maintaining a delta C-peptide level of 1.0 ng/mL or greater on a glucagon stimulation test, the utilization of donors, who possesses more than equal to 3 of the donor factors identified in this study, should be carefully considered.

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Section: Discussionmentioning

confidence: 94%

mentioning

confidence: 99%

An Examination of Donor Factors That Impact the Results of the Glucagon Stimulation Test as an Assessment of the Pancreatic Graft Endocrine Function

et al. 2022

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“…Successful SPKT is mainly dependent on the optimization of several clinical and paraclinical parameters [ 5 , 10 , 28 ]. To the best of our knowledge, this is the first study investigating the effect of MAP at reperfusion on graft function and postoperative outcome, as well as long-term graft survival, in a larger cohort of SPKT recipients.…”

Section: Discussionmentioning

confidence: 99%

Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Sucher

Schiemanck

Hau

et al. 2022

JCM

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Objectives: Adequate organ perfusion, as well as appropriate blood pressure levels at the time of unclamping, is crucial for early and long-term graft function and outcome in simultaneous pancreas–kidney transplantation (SPKT). However, the optimal intraoperative mean arterial pressure (MAP) level has not well been defined. Methods: From a prospectively collected database, the medical data of 105 patients undergoing SPKT at our center were retrospectively analyzed. A receiver operating characteristic (ROC) analysis was preliminarily performed for optimal cut-off value for MAP at reperfusion, to predict early pancreatic graft function. Due to these results, we divided the patients according to their MAP values at reperfusion into <91 mmHg (n = 47 patients) and >91 mmHg (n = 58 patients) groups. Clinicopathological characteristics and outcomes, as well as early graft function and long-term survival, were retrospectively analyzed. Results: Donor and recipient characteristics were comparable between both groups. Rates of postoperative complications were significantly higher in the <91 mmHg group than those in the >91 mmHg group (vascular thrombosis of the pancreas: 7 (14%) versus 2 (3%); p = 0.03; pancreatitis/intraabdominal abscess: 10 (21%) versus 4 (7%); p = 0.03; renal delayed graft function (DGF): 11 (23%) versus 5 (9%); p = 0.03; postreperfusion urine output: 106 ± 50 mL versus 195 ± 45 mL; p = 0.04). There were no significant differences in intraoperative volume repletion, central venous pressure (CVP), use of vasoactive inotropic agents, and the metabolic outcome. Five-year pancreas graft survival was significantly higher in the >91 mmHg group (>91 mmHg: 82% versus <91 mmHg: 61%; p < 0.01). No significant differences were observed in patient and kidney graft survival at 5 years between both groups. Multivariate Cox regression analysis affirmed MAP < 91 mmHg as an independent prognostic predictor for renal DGF (HR 3.49, 1.1–10.8, p = 0.03) and pancreas allograft failure (HR 2.26, 1.0–4.8, p = 0.01). Conclusions: A MAP > 91 mmHg at the time point of reperfusion was associated with a reduced rate of postoperative complications, enhancing and recovering long-term graft function and outcome and thus increasing long-term survival in SPKT recipients.

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“…Similarly, donor hyperglycemia or need for insulin therapy could be related to the physiological response to injury or administration of exogenous glucose and steroids. Consequently, these factors should not be considered a contraindication for transplantation in the absence of a donor history of diabetes 29,30 . Donor hemodynamic instability and vasopressor requirement implies inadequate perfusion and may increase the risk of graft thrombosis.…”

Section: Introductionmentioning

confidence: 99%

“…Consequently, these factors should not be considered a contraindication for transplantation in the absence of a donor history of diabetes. 29,30 Donor hemodynamic instability and vasopressor requirement implies inadequate perfusion and may increase the risk of graft thrombosis. The visual inspection, texture, and consistency of the pancreas provide valuable information at the time of procurement, especially fatty infiltration, or any injury, although these findings are hard to quantify.…”

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confidence: 99%

Poor utilization of deceased donor pancreata in the United States: Time for action

Singh,

Stratta

2023

Clinical Transplantation

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The number of solid organ pancreas transplants performed in the United States has declined over the past two decades despite improving outcomes and the known benefits associated with this procedure. Although the reasons are multifactorial, high rates of deceased donor pancreata nonrecovery and nonuse have at least in part contributed to the reduction in pancreas transplant activity. The pancreas has higher nonrecovery and nonuse rates compared to the kidney and liver because of more stringent donor selection criteria, particularly with respect to donor age and body mass index, although even marginally inferior donor pancreata likely still benefit some patients compared to alternative therapies. In this editorial, we present several donor‐, candidate‐, and center‐specific factors that are either confirmed or suspected of being associated with inferior outcomes, which contribute to high pancreas nonrecovery and nonuse rates. In addition, we have discussed several measures to increase pancreas recovery and reduce pancreas nonutilization.

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Donor risk factors in pancreas transplantation

Cited by 5 publications

References 39 publications

An Examination of Donor Factors That Impact the Results of the Glucagon Stimulation Test as an Assessment of the Pancreatic Graft Endocrine Function

An Examination of Donor Factors That Impact the Results of the Glucagon Stimulation Test as an Assessment of the Pancreatic Graft Endocrine Function

Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Poor utilization of deceased donor pancreata in the United States: Time for action

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