Pancreas utilization rates in the UK – an 11‐year analysis

Abstract

Utilization of pancreases for transplantation remains inferior to that of other organs. Herein, we analysed UK pancreas discards to identify the reasons for the low utilization rates. Data on all pancreases offered first for solid organ transplantation between 1st January 2005 and 31st December 2015 were extracted from the UK Transplant Registry. The number of organs discarded, reasons and the time point of discard were analysed. A centre specific comparison was also undertaken. 7367 pancreases were offered first for solid organ transplantation. 35% were donors after circulatory death (DCD). 3668 (49.7%) organs were not retrieved. Of the 3699 pancreases retrieved, 38% were initially accepted but subsequently discarded. 2145 (29%) grafts offered were transplanted as simultaneous pancreas-kidney or solitary pancreas. 1177 (55%) were transplanted on the first offer whilst the remaining 968 were transplanted after a median of three offers. 52% DBD pancreases were accepted and transplanted on the first offer compared with 68% DCD grafts. There were significant differences in discard rates between centres (30-80% for DBD and 3-78% for DCD, P < 0.001). A significant number of solid pancreases are discarded. Better graft assessment at retrieval could minimize unnecessary organ travel and discards. Closer links with islet programmes may allow for better utilization of discarded grafts.

Cell Therapy for Type 1 Diabetes: From Islet Transplantation to Stem Cells

“…A quarter of patients may remain insulin independent, with HbA1c concentrations of less than or equal to 6.5%, for at least 10 years, with either islet transplantation alone or isletafter-kidney transplantation [55]. Moreover, the glucose control associated with excellent islet graft function closely matches glucose values measured in healthy adults: median glucose 103 mg/dL (95)(96)(97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109)(110)(111)(112), glucose standard deviation around the mean value 14 (11-20), 0% time >180 mg/dL, 0% time <54 mg/dL, HbA1c 5.6 (5-5.8) [56]. Additionally, a significant improvement of quality of life after islet transplant has been documented by using standardized psychometric instruments and interviews carried on by psychologists [47,[57][58][59][60][61][62][63][64].…”

“…1). Efforts are ongoing to push to a broader dimension islet transplantation [54], including (i) implementation of scheme for donor and recipient selection and organ allocation to increase pancreas utilization [94][95][96]; (ii) improvement and standardization of islet isolation process and its best codification by regulatory bodies [97][98][99][100]; (iii) monitoring of transplanted islets by noninvasive imaging techniques [101,102]; (iv) development of biomarkers to assess the efficacy of the immunosuppression/immunomodulation strategies [92,[103][104][105][106][107]; (v) identification of alternative transplantation sites [108]; (vi) creation of an ideal bio-artificial niche for islet survival by bioengineering approaches [109,110]; and (vii) use of immune-isolation techniques, such as hydrogel polymers that shield pancreatic islet from immune cell attack [111,112]. On the other hand, there is increasing enthusiasm for the use of unlimited alternative sources of transplantable insulin-producing cells.…”

O Pancreas, Where Art Thou?

“…There are ominous trends signaling that pancreas transplantation activity has flat-lined globally (Angelika Gruessner, personal communication, January 2023). 4,[17][18][19][20][21][22] The annual number of non-US cases surpassed cases in the United States in 2008 and has continued over time. 4 The number of pancreas transplants performed globally peaked at about 2600 in 2011, declined to 2000 in 2020 during the COVID-19 pandemic, and slowly recovered to about 2100 in 2021.…”

“…18 In the United Kingdom, from 2009 to 2016, the pancreas nonrecovery rate was 49.7%, and the discard rate following pancreas recovery was 38%. 19 The number of pancreas transplants performed in the United Kingdom decreased from 214 in 2013/2014 to 131 in 2021/2022. 20 In the Australia/New Zealand registry, only 36 SPKTs and 1 PAK transplant were performed in 2021, which was down from 52 pancreas transplants performed in 2016.…”

Reanimating Pancreatic Grafts Subjected to Prolonged Cold Ischemic Injury Using Normothermic Ex Vivo Perfusion

“…2 The causes for this could be multifactorial, mostly attributed to organ-related factors, including cold ischemia time (CIT), graft steatosis, donor age, and mode of death (cardiac versus brain death), rather than the availability of organs. 3 Factors such as organ recovery, packaging, transportation from the retrieval center to the recipient hospital (across cities or provinces), back-table preparation, and recipient characteristics might all contribute to increasing the cold preservation time of the graft. 4,5 Studies have shown prolonged CS of the pancreas graft (>12 h) to be associated with graft failure, thereby leading to the inclusion of this factor in the calculation of the pancreas donor risk index.…”