Outcomes of Pancreas Transplantation in the United States Using Cardiac-Death Donors

Salvalaggio, Paolo R.O.; Davies, Darcy B.; Fernández, Luis A.; Kaufman, Dixon B.

doi:10.1111/j.1600-6143.2006.01310.x

Cited by 82 publications

(66 citation statements)

References 29 publications

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“…In addition, planned recipients of both DCD and DBD organs were admitted before the donor went to theatre (DBD) or had treatment withdrawn (DCD). In this study, cold ischaemia times in the DBD group were thus substantially lower than those reported elsewhere 14 , although this policy did, on several occasions, result in the recipient not receiving a transplant because the organs were unsuitable on inspection or, for DCD donors, asystole did not occur within 4 h after treatment withdrawal.…”

Section: Discussioncontrasting

confidence: 63%

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Outcomes of simultaneous pancreas–kidney transplantation from brain-dead and controlled circulatory death donors

Qureshi

Callaghan

Bradley

et al. 2012

British Journal of Surgery

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Section: Discussioncontrasting

confidence: 63%

“…The largest report is from an United Network of Organ Sharing registry analysis of 47 DCD SPK transplants that showed equivalent graft survival rates at 1, 3 and 5 years for organs from DCD and DBD donors 14 . Single-centre long-term follow-up has shown no difference in patient and graft survival at 8 years 13 .…”

Section: Introductionmentioning

confidence: 99%

Outcomes of simultaneous pancreas–kidney transplantation from brain-dead and controlled circulatory death donors

Qureshi

Callaghan

Bradley

et al. 2012

British Journal of Surgery

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“…The incidence reported in the literature ranges from 1% to 40% and accounts for 29% of grafts lost within the first 6 months after transplantation 3, 4. Reported risk factors for PAT include donor age, body mass index (BMI), atherosclerosis, donation after circulatory death (DCD), death from cerebrovascular accident, and premortem severe hypotension 5, 6. Recipient risk factors include vascular disease, thrombophilic state, history of previous thrombotic events, and hypotension in the intraoperative or postoperative period 3.…”

Section: Introductionmentioning

confidence: 99%

Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm

Hakeem

Chen

Iype

et al. 2018

American Journal of Transplantation

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Pancreatic allograft thrombosis (PAT) remains the leading cause of nonimmunologic graft failure. Here, we propose a new computed tomography (CT) grading system of PAT to identify risk factors for allograft loss and outline a management algorithm by retrospective review of consecutive pancreatic transplantations between 2009 and 2014. Triple‐phase CT scans were graded independently by 2 radiologists as grade 0, no thrombosis; grade 1, peripheral thrombosis; grade 2, intermediate non‐occlusive thrombosis; and grade 3, central occlusive thrombosis. Twenty‐four (23.3%) of 103 recipients were diagnosed with PAT (including grade 1). Three (2.9%) grafts were lost due to portal vein thrombosis. On multivariate analysis, pancreas after simultaneous pancreas–kidney transplantation/solitary pancreatic transplantation, acute rejection, and CT findings of peripancreatic edema and/or inflammatory change were significant risk factors for PAT. Retrospective review of CT scans revealed more grade 1 and 2 thromboses than were initially reported. There was no significant difference in graft or patient survival, postoperative stay, or morbidity of recipients with grade 1 or 2 thrombosis who were or were not anticoagulated. Our data suggest that therapeutic anticoagulation is not necessary for grade 1 and 2 arterial and grade 1 venous thrombosis. The proposed grading system can assist clinicians in decision‐making and provide standardized reporting for future studies.

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“…At the other extreme, several studies have shown reduced long-term pancreas graft survival with pancreata from donors older than 50 years of age [21,22]. Although fewer than 5% of all pancreas transplants are obtained from donors after cardiac death, there are recent reports of excellent longterm graft survival with pancreata from donors after cardiac death, comparable to that of pancreata from brain dead donors [23,24]. However, the incidence of delayed kidney graft function was significantly higher in recipients of organs from donors after cardiac death in these studies.…”

Section: Discussionmentioning

confidence: 99%

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center

et al. 2011

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■ AbstractThis article reviews the outcome of pancreas transplantations in diabetic recipients according to risk factors, surgical techniques, and immunosuppression management that evolved over the course of a decade at Wake Forest Baptist Medical Center. A randomized trial of alemtuzumab versus rabbit anti-thymocyte globulin (rATG) induction in simultaneous kidney-pancreas transplantation (SKPT) at our institution demonstrated lower rates of acute rejection and infection in the alemtuzumab group. Consequently, alemtuzumab induction has been used exclusively in all pancreas transplantations since February 2009. Early steroid elimination has been feasible in the majority of patients. Extensive experience with surveillance pancreas biopsies in solitary pancreas transplantation (SPT) is described. Surveillance pancreas biopsy-directed immunosuppression has contributed to equivalent long-term pancreas graft survival rates in SKPT and SPT recipients at our center, in contrast to recent registry reports of persistently higher rates of immunologic pancreas graft loss in SPT. Furthermore, the impact of donor and recipient selection on outcomes is explored. Excellent results have been achieved with older (extended) donors and recipients, in recipients of organs from donation after cardiac death donors managed with extracorporeal support, and in African-American patients. Type 2 diabetics with detectable C-peptide levels have been transplanted successfully with outcomes comparable to those of insulinopenic diabetics. Our experiences are discussed in the light of findings reported in the literature.

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Outcomes of Pancreas Transplantation in the United States Using Cardiac-Death Donors

Cited by 82 publications

References 29 publications

Outcomes of simultaneous pancreas–kidney transplantation from brain-dead and controlled circulatory death donors

Outcomes of simultaneous pancreas–kidney transplantation from brain-dead and controlled circulatory death donors

Pancreatic allograft thrombosis: Suggestion for a CT grading system and management algorithm

Pancreas Transplantation: Lessons Learned From a Decade of Experience at Wake Forest Baptist Medical Center

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