The allocation of pancreas allografts on donor age and duration of intensive care unit stay: the experience of the North Italy Transplant program

Abstract

SummaryStarting in 2011, the North Italy Transplant program (NITp) has based on the allocation of pancreas allografts on donor age and duration of intensive care unit (ICU) stay, but not on donor weight or BMI. We analyzed the detailed allocation protocols of all NITp pancreas donors (2011-2012; n = 433). Outcome measures included donor characteristics and pancreas loss reasons during the allocation process. Twenty-three percent of the 433 pancreases offered for allocation were transplanted. Younger age, shorter ICU stay, traumatic brain death, and higher eGFR were predictors of pancreas transplant, either as vascularized organ or as islets. Among pancreas allografts offered to vascularized organ programs, 35% were indeed transplanted, and younger donor age was the only predictor of transplant. The most common reasons for pancreas withdrawal from the allocation process were donor-related factors. Among pancreas offered to islet programs, 48% were processed, but only 14.2% were indeed transplanted, with unsuccessful isolation being the most common reason for pancreas loss. Younger donor age and higher BMI were predictors of islet allograft transplant. The current allocation strategy has allowed an equal distribution of pancreas allografts between programs for either vascularized organ or islet transplant. The high rate of discarded organs remained an unresolved issue.

Donor risk indices in pancreas allocation in the Eurotransplant region

“…With traumatic brain injuries, elevated amylase, as one of the P‐PASS factors, does not have to be related to pancreas injury, but increases the P‐PASS score . Duration of ICU stay and vasopressor use, P‐PASS but not a PDRI factors, are associated with pancreas being declined for transplantation . Because these donors are declined for transplantation, there is little evidence to support that finding.…”

“…This donor scoring system, which was one of the first quantitative donor scoring systems, consists solely of donor factors (age, body mass index (BMI), duration of intensive care unit (ICU) stay, duration of asystole, sodium, amylase, lipase and inotropic therapy). The system identifies a suitable pancreas donor, using a cut-off value of 17 (range [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]. Its intention was to educate and inform transplant professionals, such as ICU clinicians referring potential donors, as well as transplant coordinators reporting donors to Eurotransplant.…”