Effect of donor pancreas extraction time on pancreas transplantation—a Swiss tertiary center experience

Abstract

We aimed to assess the effect of donor pancreas extraction time (ET) on postoperative complications and graft function after pancreas transplantation (PT). We analyzed all consecutive donor pancreas procurements for the simultaneous pancreas and kidney transplantation (SPK) and the associated PT in a Swiss transplant center over a 20-year period. Pancreas ET was defined as the time from cold flush to static storage of the pancreas on ice. The primary endpoint was the effect of extraction time on surgical complications. Secondary endpoints comprised the effect of ET on graft function (insulin-free survival) and graft pancreatitis. Of 115 procured pancreas grafts the median donor pancreas ET was 65 min (IQR: 48-78 min). In multivariable analysis, ET did not negatively affect major complications (OR 1.41 [95% CI: .59-3.36]; p = .438) and insulin-free survival (HR 1.42 [95% CI: .55-3.63]; p = .459). The median CIT was 522 (441-608) min. CIT was associated with major complications (OR 2.51 [95% CI:1.11-5.68]; p = .027), but without impact on insulin-free survival (HR 1.94 [95% CI:.84-4.48]; p = .119). Patients with and without graft pancreatitis had no statistically significant differences in ET and CIT (p = .164 and p = .47, respectively). In multivariable analysis, Amylase levels > 270 U/L on postoperative day 1 were significantly associated with major complications ]; p = .040). Our results suggest that although no effect of ET on complications and graft function after PT was found, shorter CIT and less graft pancreatitis can have a positive impact on surgical complications. Results could possibly be influenced by the exceptional quality of the pancreas donors, with short travel distances and preservation times in Switzerland.

Simultaneous Pancreas and Kidney Transplantation from Donors after Circulatory Death in Switzerland

“…These results even outstand deceased kidney donation alone and are similar to that of living donor KT. The data from our own center shows similar encouraging results for pancreas and kidney graft survival after SPK [ 26 ], highlighting it as a highly effective and promising procedure. In detail, in our series of PT between 2001 and 2020, insulin-free survival at 1, 5, and 10 years, was 89.5%, 81.5%, and 78.3%, respectively.…”

“…All three recipients were transplanted without DSA and did not show any formation of de novo DSA. Regarding kidney function, it must be said that our cohort of DBD-SPK showed better long-term results in comparison, with a median GFR of 67 and 69.5 mL/min after 1 and 3 years [ 26 ]. However, comparing such a large cohort with the first three DCD-SPK alone is not realistic and should be interpreted with great caution.…”