The Outcomes of Pancreatic Transplantation from Pediatric Donors–A Single Institution Experience

Ito, Taihei; Kenmochi, Takashi; Aida, Naohiro; Kurihara, Kei; Kawai, Maki; Suzuki, Atsushi; Shibata, Megumi; Hayashi, Izumi; Hasegawa, Midori

doi:10.3390/jcm8091386

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…Another issue to consider is whether the insulin secretory capacity of the small grafts is sufficient. However, this is acceptable in light of some reports of good insulin secretory capacity and prognosis in pancreas transplants from pediatric donors, 31,32 which generally involve small grafts. Interestingly, sex mismatch was not a statistically significant factor for graft failure; however, an association was suggested in the univariate analysis ( p = .06), as shown in Table 3.…”

Section: Discussionmentioning

confidence: 99%

Size‐mismatched transplantation from large donors to small recipients is associated with pancreas graft thrombosis: A retrospective national observational study

Kaku

Okabe

Kubo

et al. 2023

Clinical Transplantation

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IntroductionDonor–recipient (D/R) size mismatch has been evaluated for a number of organs but not for pancreas transplantation.MethodsWe retrospectively evaluated 438 patients who had undergone pancreas transplantation. The D/R body surface area (BSA) ratio was calculated, and the relationship between the ratio and graft prognosis was evaluated. We divided the patients into two groups and evaluated graft survival. The incidence of pancreas graft thrombosis resulting in graft failure within 14 days and 1‐year graft survival were compared using Kaplan–Meier curves, and the prognostic factors associated with graft thrombosis were identified by univariate and multivariate analyses.ResultsThe mean/median donor and recipient BSAs were 1.63 m2/1.65 m2, and 1.57 m2/1.55 m2, respectively; the mean and median D/R BSAs were both 1.05. The receiver operating characteristic curve cutoff for the D/R BSA ratio was 1.09, and significant differences were identified between patients with ratios of ≥1.09 (high group) versus <1.09 (low group). The incidence of graft thrombosis resulting in pancreas graft failure within 14 days was significantly higher in the high group than in the low group (p < .01). One‐year overall and death‐censored pancreas graft survival were significantly higher in the low group than in the high group (p < .01). Multivariate analysis identified recipient height, donor BSA, and donor hemoglobin A1c as significant independent factors for graft thrombosis. Cubic spline curve analysis indicated an increased risk of graft thrombosis with increasing D/R BSA ratio.ConclusionD/R size mismatch is associated with graft thrombosis after pancreas transplantation.

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Section: Discussionmentioning

confidence: 99%

Size‐mismatched transplantation from large donors to small recipients is associated with pancreas graft thrombosis: A retrospective national observational study

Kaku

Okabe

Kubo

et al. 2023

Clinical Transplantation

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“…Patients who are determined to be indicated for pancreatic transplantation are registered on the waiting list of the Japan Organ Transplant Network. Recipient selection is performed according to conditions that have already been published 20 . In brief, recipient selection is performed based on the following conditions: the blood type must be compatible, and a direct crossmatch test must be negative.…”

Section: Methodsmentioning

confidence: 99%

“…Recipient selection is performed according to conditions that have already been published. 20 In brief, recipient selection is performed based on the following conditions: the blood type must be compatible, and a direct crossmatch test must be negative. Recipients on the waiting list are prioritized for selection as follows: (1) fewer human leukocyte antigen mismatches; (2) operation procedure in the order of SPK, pancreas transplantation after kidney transplantation (PAK), and pancreas transplantation alone (PTA); (3) the length of the waiting period; and (4) a shorter estimated transport time for organs.…”

Section: Indication Of Pancreas Transplantationmentioning

confidence: 99%

An Examination of Donor Factors That Impact the Results of the Glucagon Stimulation Test as an Assessment of the Pancreatic Graft Endocrine Function

et al. 2022

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ObjectivesDelta C-peptide derived by the glucagon stimulation test is a reliable value for the evaluation of the pancreatic endocrine function after pancreas transplantation. We examined the associations between delta C-peptide as pancreatic graft endocrine function and donor background factors.MethodsSixty-five cases of pancreatic transplantation from brain-dead donors, which were performed in our facility, were enrolled in this study. Enrolled recipients underwent a glucagon stimulation test within 1 to 3 months after transplantation to evaluate the pancreatic graft endocrine function with delta C-peptide to compare donor background factors.ResultsThe following factors were associated with significant deterioration of the delta C-peptide: age of 50 years or greater, death from cerebrovascular accident, hemoglobin A1c level of 5.6% or greater, creatinine level of 1.0 mg/dL or greater, C-reactive protein level of 25 mg/dL or greater, and sodium level of 150 mmol/L or greater. In addition, increased numbers of these donor factors indicated significantly greater deterioration of the posttransplant pancreatic endocrine function (P < 0.001).ConclusionsTo secure insulin independence after pancreas transplantation, which means maintaining a delta C-peptide level of 1.0 ng/mL or greater on a glucagon stimulation test, the utilization of donors, who possesses more than equal to 3 of the donor factors identified in this study, should be carefully considered.

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“…Patients who are determined to be indicated for pancreatic transplantation are registered on the waiting list of the Japan Organ Transplant Network (JOT). Recipient selection is performed according to conditions that have already been published [17,18]. Briefly, recipient selection is performed based on the following conditions: The blood type must be compatible, and a direct crossmatch test must be negative.…”

Section: Enrolled Patientsmentioning

confidence: 99%

Impact of Pancreas Transplantation on the Patient Survival—An Analysis of the Japanese Pancreas Transplants Registry

Ito

Kenmochi

Aida

et al. 2020

JCM

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Background: The impact of pancreas transplantation, including kidney transplantation on patients’ life prognoses, is unclear in Japan. An analysis of the data of the Japan Pancreas Transplant Registry was performed to compare the patient survival between on the waiting list and after pancreas transplantation, and investigate the factors that affect the patient survival after pancreatic transplantation. Methods: The life prognoses of 361 patients who underwent pancreas transplantation from 2000 to December 2018 were examined. Results: The survival rates at 1, 5, and 10 years on the waiting list were 98.4%, 90.3%, and 78.1%, respectively, while those after transplantation were significantly improved (p = 0.029) at 100%, 97.5%, and 88.9%, respectively. Furthermore, the survival rates of patients waiting for simultaneous pancreas and kidney transplantation (SPK) at 1, 5, and 10 years were 98.2%, 89.4%, and 75.4%, respectively, while those after SPK were also significantly improved (p = 0.026) at 100%, 94.6%, and 88.8%. The multivariable analysis revealed that the duration of diabetes before surgery was the only independent risk factor (hazard ratio = 1.095, p = 0.012) that affected the patient survival after SPK. Conclusion: Pancreas transplantation was found to improve the life prognosis of patients with type 1 diabetes, especially those with end-stage renal failure waiting for SPK.

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The Outcomes of Pancreatic Transplantation from Pediatric Donors–A Single Institution Experience

Cited by 5 publications

References 24 publications

Size‐mismatched transplantation from large donors to small recipients is associated with pancreas graft thrombosis: A retrospective national observational study

Size‐mismatched transplantation from large donors to small recipients is associated with pancreas graft thrombosis: A retrospective national observational study

An Examination of Donor Factors That Impact the Results of the Glucagon Stimulation Test as an Assessment of the Pancreatic Graft Endocrine Function

Impact of Pancreas Transplantation on the Patient Survival—An Analysis of the Japanese Pancreas Transplants Registry

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