The Role of Pre-Procurement Pancreas Suitability Score (P-PASS) and Pancreas Donor Risk Index (PDRI) in the Outcome of Simultaneous Pancreas and Kidney or Pancreas After Kidney Transplantation

Abstract

Background The pre-procurement pancreas suitability score (P-PASS) and the pancreas donor risk index (pDRI) are established predictive scores for graft survival and patient outcome following pancreatic transplantation. This retrospective study aimed to evaluate the predictive value of P-PASS and pDRI following simultaneous pancreas and kidney (SPK) transplantation, or pancreas after kidney (PAK) transplantation, and the clinical impact of donor-specific factors on the postoperative graft and recipient outcome at a single transplant center. Material/Methods The study included 105 patients who underwent SPK (n=104) or PAK (n=4) between 2000 and 2017. Donor-specific and recipient-specific parameters were recorded. Kaplan-Meier analysis and Cox regression analysis were used to assess the outcome after transplantation. Results Overall, the mean 1-year and 5-year pancreas graft survival and patient survival rates were 78.7% and 93.2%, and 76.9% and 90.0%, respectively. The postoperative outcome in patients with a P-PASS score of <17 was not significantly different when compared with patients with a score of ≥17. A P-PASS score of ≥17 was significantly associated with early pancreas graft loss (p=0.04). There was no significant difference in postoperative outcome between patients with high pDRI and low pDRI. Smoking of donor (p=0.046) was a risk factor and coronary heart disease of recipient (p=0.003) had a significant effect on survival of pancreas graft. Conclusions This study showed that P-PASS and pDRI were not reliable predictors of outcome after pancreas transplantation and that specific characteristics of the donor and recipient must be evaluated when predicting the outcome of pancreas transplantation.

Risk indices predicting graft use, graft and patient survival in solid pancreas transplantation: a systematic review

“…This was handled by complete case analysis in all eight studies. Three studies had no missing data [ 34 , 38 , 41 ] and one study did not report missing data [ 45 ]. Graft failure was not defined in three studies (23%) [ 36 , 39 , 45 ].…”

“…In these studies, PDRI was classified either as ‘high’ or ‘low’ according to the median PDRI within the cohort, or in tertiles. Furthermore, donor race was classified differently to that of PDRI derivation in one study due to differences in that country [ 36 ] and was not clearly classified in two studies [ 11 , 38 ] (not reported with other study variables). P-PASS was also validated while omitting serum sodium in one study due to lack of reporting in that jurisdiction [ 45 ].…”

“…However, domains for ‘Participants’, ‘Predictors’ recorded low risk of bias for all 12 studies, while ‘Outcomes’ had low risk of bias in nine studies (75%). ‘Applicability’ was rated low for two studies(17%) [ 36 , 45 ] due to predictors being modified as previously described, and unclear for four studies [ 11 , 38 , 39 , 41 ] due to lack of information on outcome definition and predictor collection.…”

“… − + − ? − − Ayami M 2016 [ 37 ] + + + − + + + − + Blok JJ 2016 [ 8 ] + + + − + + + − + Franz C 2019 [ 38 ] + + + − + ? + − ?…”

Expanding pancreas donor pool by evaluation of unallocated organs after brain death

“…[ 9 – 13 ] The 1- and 5-year patient survival rates after PTx are approximately 95% and 85%, respectively, and the 1-, and 5-year graft survival rates are 90%, and 70%, respectively. [ 10 , 13 , 14 ]…”