Patient and Graft Survival Implications of Simultaneous Pancreas Kidney Transplantation From Old Donors

Abstract

We investigated graft and patient survival implications of simultaneous pancreas kidney (SPK) transplant from old donors. Data describing patients with type 1 diabetes mellitus listed for an SPK transplant from 1994 to 2005 were drawn from Organ Procurement and Transplant Network registries. Allograft survival, patient survival and long-term survival expectations among SPK recipients from young (age <45 years) and old (age ≥45 years) donors were modeled by multivariate regression. We also examined predictors of reduced early access to young donor transplants. Of 16496 eligible SPK candidates, 8850 patients (53.6%) received an SPK transplant and 776 (8.8%) of these transplants were from old donors. Reasonable 5-year, death-censored kidney (77.8 %) and pancreas (71.3%) survivals were achieved with old donors. SPK transplantation from both young and old donors predicted lower mortality compared to continued waiting. An additional expected wait of 1.5 years for a young donor equalized long-term survival expectations to that achieved with use of old donors. Early allocation of young donor transplants declined in the more recent era and varied by region, candidate age, blood type and sensitization. We conclude that old SPK donors should be considered for patients with decreased access to young donor transplants. Prospective evaluation of this practice is needed.

Antibody-Mediated Rejection of the Kidney after Simultaneous Pancreas-Kidney Transplantation

“…This finding is not surprising because it is widely known that donor age and donor kidney function are closely related to graft survival after SPK transplantation. 5,29 Our study suggests that most AMR episodes in SPK transplant recipients can be diagnosed in a similar way as in isolated kidney transplantation, with the triad of allograft dysfunction, C4d positivity in PTC, and detectable DSA in recipient serum. 9,30,31 Some of the cases reported here with C4d staining and allograft dysfunction are almost undoubtedly AMR episodes, despite the lack of DSA at the time of diagnosis.…”

“…In our series, peak panel reactive antibody was marginally associated with AMR, but the significance was lost when we adjusted for female gender. Although the association of female gender with graft loss was previously reported in a registry-based study, 5 all cases of pancreas AMR published to date have occurred in men. 20,21 In addition to female gender, a high donor serum creatinine was an independent risk factor for both kidney and pancreas graft loss.…”

“…1 Excellent short-and long-term patient, kidney, and pancreas survival rates are achieved when the organs are retrieved from young donors. [1][2][3][4][5] In recent years, surgical technical improvements 6 and the introduction of the new immunosuppressive agents tacrolimus and mycophenolate mofetil (MMF) 7 have further improved the short-term results; however, rejection is detrimental to short-and long-term function of any organ transplant. Classical acute T cell rejection (ACR) can be treated effectively with steroids.…”

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

“…The ongoing imbalance between the supply and demand of suitable donor organs has led to lengthening transplant waiting lists 3 and a search for new sources of grafts. These sources include living donors 4 , paediatric deceased donors 5 , and older or overweight donation after brain death (DBD) donors 6,7 . Pancreas procured from donation after circulatory death (DCD) donors may offer a further alternative.…”

Pancreas Transplantation of Non-Traditional Recipients

“…Donor age is a well-defined risk factor that influences outcomes following pancreas transplantation, particularly SPKT [37][38][39][40]. Donor age >45 years has been associated with poor outcomes, particularly in graft function and post-transplant glycemic control.…”