Pancreas transplants from small donors: are the outcomes acceptable? A retrospective study

Abstract

Despite good organ quality, pancreata from extremely small pediatric donors (<30 kg) are generally avoided by many centers because of concerns of reduced islet cell mass and early technical failure. Therefore, we sought to compare the outcomes of small pancreas grafts (<30 kg) to those from higher weight donors from transplants performed between 1994 and 2015 (n = 1183). A total of 33 pancreata were from donors' ≤30 kg (3%), with a mean weight of 23.8 kg and mean age of 7.8 years. Patient survival was similar at 1, 5, and 10 years between recipients of ≤30 and >30 kg donors (≤30 kg: 96.8%, 86.8%, and 78.1% vs. >30 kg: 96.8%, 89.5%, and 79.1%, P = 0.5). Pancreas graft survival at 1, 5, and 10 years was also similar, ≤30 kg: 93.9%, 73.2%, and 61.0% vs. >30 kg: 87%, 73.3%, and 58.3% (P = 0.7). This graft survival pattern was also seen when comparing pancreata from ≤20 kg donors to those from >20 to 30 kg. Cause of graft loss, and metabolic and physiologic outcomes did not differ between the groups. After assessing the impact of donor weight as a continuous variable and calculating recipient-to-donor weight ratio (RDWR), we observed no effect of donor weight on patient and graft outcomes.

When pancreata fly: Outcomes and lessons learned from the development of a Pancreas Transplant Import Program

“…The use of grafts from these types of donors has been previously demonstrated to be safe and has been encouraged by expert consensus, however, nationally only 18.9% of pancreas transplants are with allografts from pediatric donors. 2,11,12,21 In our cohort, no difference in outcomes was seen among transplants using these donors, whether imported or local. We consider offers of grafts from pediatric donors down to a minimum weight of 15 kg for all recipients and use pancreata from these donors regardless of organ or vessel size.…”

“…Notably, and not reported on in previous studies, our cohort of imported pancreata included 52.5% grafts from pediatric donors and 25% donors weighing <30 kg. The use of grafts from these types of donors has been previously demonstrated to be safe and has been encouraged by expert consensus, however, nationally only 18.9% of pancreas transplants are with allografts from pediatric donors 2,11,12,21 . In our cohort, no difference in outcomes was seen among transplants using these donors, whether imported or local.…”

“…Expert consensus has recommended broadening acceptance criteria to increase transplantation, including accepting grafts from older donors (>40 years old), pediatric donors (<18 years old), and donors outside of traditional BMI and weight ranges (>30 kg/m 2 or <15 kg) 2 . However, there have not been notable increases in the transplantation of these extended criteria organs since the recommendations were made 2,11,12 . In 2020, 962 total pancreas transplants were performed in the United States.…”