Improving pancreas graft utilization through importation

Abstract

Background: We analyze our outcomes utilizing imported allografts as a strategy to

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

“…Given the sample size and time‐period, we were unable to perform more detailed analysis into causes for graft failure, rates of early rejection, and longer‐term outcomes. However, our results support previous reports of excellent outcomes and decreased wait times with imported grafts 14–17 . The trend we observed towards better outcomes with imported grafts suggests that importation may give patients access to higher‐quality pancreata than they otherwise would have received.…”

“…Torabi et al. and Choinski et al., reporting on their center's early experience with an importation program implemented, like ours, in Region 9 in 2014, found no difference in patient or graft outcomes when comparing 16 local to 10 imported grafts and 17 local to 11 imported grafts 16,17 . As with our center, a significant motivation for pancreas importation for this group was the lengthy wait times in this high‐competition region.…”

“…15 imported grafts. 16,17 As with our center, a significant motivation for pancreas importation for this group was the lengthy wait times in this high-competition region. Interestingly, they found importation only significantly decreased wait times for SPK recipients, while we found that those awaiting PAK saw the most marked decrease in wait time.…”

“…Cost analysis was unfortunately not feasible as part of our study due to the policies at our institution, which preclude clinical departments from accessing financial records unless there is a deficit. Previous studies have highlighted that the cost of importation should not be expected to be overly burdensome and should be weighed against the benefits to patients, and the goals of the transplant center to deliver access to the best organs in the shortest time 16,17 . The motivation of OPOs to increase their organs per donor in underutilized areas makes them amenable to waivers, which can further help offset added costs and risks.…”

“…While studies have shown that these imported pancreata can be successfully transplanted with excellent outcomes, transplant centers may be wary to accept organs imported from outside of their 250 nautical mile (NM) Organ Procurement and Transplantation Network (OPTN) Allocation System locality due to concerns of longer cold ischemic times as well as the need to utilize an unfamiliar surgical team. [14][15][16][17] Additionally, transplant teams and hospital administrations may have questions regarding the logistical feasibility and utility of initiating an effective importation protocol. If these fears can be overcome, imported grafts represent a valuable opportunity for the center and recipient alike.…”