Pancreas Transplantation from Donors after Circulatory Death: an Irrational Reluctance?

Abstract

Purpose of Review Beta-cell replacement is the best therapeutic option for patients with type 1 diabetes. Because of donor scarcity, more extended criteria donors are used for transplantation. Donation after circulatory death donors (DCD) are not commonly used for pancreas transplantation, because of the supposed higher risk of complications. This review gives an overview on the pathophysiology, risk factors, and outcome in DCD transplantation and discusses different preservation methods. Recent Findings Studies on outcomes of DCD pancreata show similar results compared with those of donation after brain death (DBD), when accumulation of other risk factors is avoided. Hypothermic machine perfusion is shown to be a safe method to improve graft viability in experimental settings. Summary DCD should not be the sole reason to decline a pancreas for transplantation. Adequate donor selection and improved preservation techniques can lead to enhanced pancreas utilization and outcome.

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

“…It is important to consider how this analysis should change transplant practices. This study strongly supports an expansion in the use of SPK transplants from controlled DCD donors 36 . In countries with relatively high DCD donor pancreas utilization rates such as the UK, the above data suggest that a careful increase in DCD donor age criteria would also be appropriate.…”

“…This study strongly supports an expansion in the use of SPK transplants from controlled DCD donors. 36 In countries with relatively high DCD donor pancreas utilization rates such as the UK, the above data suggest that a careful increase in DCD donor age criteria would also be appropriate. In those countries with limited (or no) experience of pancreas transplantation from DCD donors, it is understandable that a more cautious initial approach may wish to be taken, seeking to limit likely risk factors for reduced pancreas graft survival such as donor age >50 years, pancreas CIT >12 h, pWIT <30 min, and prolonged anastomosis times while experience with this donor source accrues.…”

First World Consensus Conference on pancreas transplantation: Part II – recommendations

“…In the setting of donation after circulatory death (DCD), the use of young controlled DCD donors was not considered a contraindication to pancreas transplantation, as evidence showed that when donor age is <40 years, results are good irrespective of donor source (i.e., DCD or DBD). 117 , 118 , 119 , 120 , 121 , 122 , 123 , 124 …”

“…In the discussion, experts underscored that the use of pediatric donors of low body weight (<15 kg) may increase the risk of technical failure, while a BMI < 35 kg/m 2 reduces the impact of obesity. In the setting of donation after circulatory death (DCD), the use of young controlled DCD donors was not considered a contraindication to pancreas transplantation, as evidence showed that when donor age is <40 years, results are good irrespective of donor source (i.e., DCD or DBD) 117–124 …”

Development of ex situ normothermic reperfusion as an innovative method to assess pancreases after preservation

“…These suboptimal donors are defined in PTx as those with a body mass index of greater than 30kg/m 2 and outside the range of <10 to >45 years of age [3]. Donation after circulatory death (DCD) status is also regarded as risk factor for accruing ischaemic injury during preservation [4].…”