Outcomes after simultaneous pancreas–kidney transplantation from donation after circulatory death donors: A UK registry analysis

Abstract

There are concerns that simultaneous pancreas-kidney (SPK) transplants from donation after circulatory death (DCD) donors have a higher risk of graft failure than those from donation after brain death (DBD) donors. A UK registry analysis of SPK transplants between 2005 and 2018 was performed. Pancreas survivals of those receiving organs from DCD or DBD donors were compared. Multivariable analyses were used to adjust for baseline differences between the two groups and to identify factors associated with pancreas graft loss. A total of 2228 SPK transplants were implanted; 403 (18.1%) were from DCD donors. DCD donors were generally younger, slimmer, less likely to have stroke as a cause of death, with lower terminal creatinines and shorter pancreas cold ischemic times than DBD donors. Median (IQR) follow-up was 4.2 (1.6-8.1) years. On univariable analysis, there were no statistically significant differences in 5-year death-censored pancreas graft survival between the two donor types (79.5% versus 80.4%; p = .86). Multivariable analysis showed no statistically significant differences in 5-year pancreas graft loss between transplants from DCD (n = 343) and DBD (n = 1492) donors (hazard ratio 1.26, 95% CI 0.76-1.23; p = .12).

Pancreas transplantation with grafts obtained from donation after cardiac death or donation after brain death results in comparable outcomes

“…This was a non-propensity matched, retrospective study, where the authors reported similar 5-year recipient survival rates between DCD and DBD groups (91.5 vs. 89.1%, p = 0.85). Five-year pancreas DCD graft survival was also in line with pancreas DBD graft survival In 2021, a recent UK registry analysis demonstrated on both univariate and multi-variate analysis no statistical difference in 5-year graft or patient survival between DCD and DBD donor groups (13). The authors identified that DCD donors were significantly younger (30 vs. 37, p < 0.01), had a lower rate of stroke (as a cause of death), had lower terminal creatinine and had lower pancreas risk index scores compared to DBD donors.…”

Sterile Pancreas Inflammation during Preservation and after Transplantation

“…Registry analysis in the UK and Sweden showed no difference in pancreas allograft survival between SPK recipients from DBD donors and DCD donors [62,63]. In both studies, CIT was shorter for DCD donors.…”

Beyond donation to organ utilization in the UK

“…Others have shown that concerns about the impact of delayed graft function on longer-term graft survival in kidneys from DCD donors are largely unfounded, though periods of delayed graft function of more than 14 days were associated with adverse graft survivals [27]. Contrary to previous work from the US that suggested that donation after circulatory death was a risk factor for diminished pancreas graft survival [28], a recent national registry analysis from the UK, where almost 20% of pancreas transplants are from DCD donors, showed no significant difference between DCD versus DBD five-year risk-adjusted pancreas graft survival [9].…”

“…The UK has high rates of organ transplantation from DCD donors [7][8][9], and a relatively old deceased donor population. For example, the median age of donors of transplanted kidneys in the UK is 52 years versus 36 years in the United States (US) [2].…”