Why Offered Pancreases Are Refused in the Allocation Process—A Descriptive Study Using Routine Data From Eurotransplant

Loss, Martin; Drewitz, Karl Philipp; Apfelbacher, Christian; Rosmalen, Marieke D. van; Rahmel, Axel; Schlitt, Hans J.; Loss, Julika

doi:10.1097/tp.0b013e318287d83f

Cited by 20 publications

(26 citation statements)

References 17 publications

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“…It seems reasonable to expand the donor pool by including organs from marginal donors. 24 To the best of our knowledge, this is the first study reporting the use of rescue organs for pancreas transplant within the Eurotransplant region area and the results at 2 years' follow-up after transplant. The results showed no differences in the rate of surgicaland organ-related long-term complications (eg, graft and patient survival) compared with CONV donors.…”

Section: Discussionmentioning

confidence: 92%

“…Loss and associates published a study on the avoidable loss of some pancreata in the allocation process after analyzing allocation protocols of all Eurotransplant-registered German whole pancreas donors between 2005 and 2009. 24 Only 37% (n = 1758) of the offered pancreata were transplanted. Seventy-five percent of grafts were lost owing to donor-related reasons.…”

Section: Discussionmentioning

confidence: 99%

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Untitled

2014

Exp Clin Transplant

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Objectives: Because of the shortage of available organs for transplants, graft allocation polices have been modified recently. This report deals with the effect of using organs after rescue allocation for pancreas transplant in a single center in the Eurotransplant Region to possibly expand the donor pool. Materials and Methods: A retrospective analysis was performed. Between 2007 and 2010, 31 pancreas transplants were performed at the University Hospital of Leipzig, in Leipzig, Germany. Among these, 7 cases used rescue organs. These organs had been officially offered to, but rejected by, at least 3 consecutive transplant centers. Donor/recipient and clinical/laboratory transplant/posttransplant outcomes from patients receiving rescue organs were collected and were compared with organs from conventional donors. Results: Mean donor age was greater in the rescue organ group than in the conventional donor group (28.3 ± 10.7 y vs 23.0 ± 12.5 y). During follow-up (2.3 ± 0.6 y rescue organ group vs 3.9 ± 1.2 y conventional donor group), patient, kidney, and pancreas graft survival rates were 85% in all 3 categories in the rescue organ group, whereas outcomes for conventional donors were 88%, 85%, and 83%. Incidences of pancreatic graft thrombosis, delayed graft function, acute and late rejection episodes (eg, perioperative complications) were comparable between groups. No differences existed between mean serum urea levels and mean HbA1c levels between groups 2 years after transplant. Whereas 2 years after surgery, mean serum creatinine levels (rescue organ group, 78.8 ± 21.0 μmol/L vs 114.3 ± 28.4 μmol/L in the conventional donor group) showed significant differences between groups. Conclusions: Results are promising. Further prospective studies are warranted to evaluate routine transplant of organs after rescue allocation.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Untitled

2014

Exp Clin Transplant

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“…Moreover, old donor SPKT resulted in reduced patient and graft survival without any waiting time benefit compared with young donor SPKT, except for candidates with expected long waiting times. In Eurotransplant, older donor age was identified as the only clinically significant factor differentiating between recovered pancreata that were transplanted (median donor age 31 years) or discarded (median donor age 42 years) [12]. In a recent, large, single-center, retrospective study, donor age >50 years, donor BMI ≥30 kg/m 2 , donor serum creatinine ≥2.5 mg/dL, and preservation time >20 hours were each identified as significant risk factors for early graft loss (within 90 days) secondary to technical failure in a multivariable Cox model, and were then used to create a composite risk model for predicting technical failure [31].…”

Section: Donor Agementioning

confidence: 99%

“…The one critical caveat is that cold ischemia times are kept below 12 hours [9][10][11]. In Eurotransplant, only 37 % of offered pancreata are transplanted and the discard rate among 'high quality' pancreata is 38 % [12]. Little doubt exists that there is profound underutilization of the pancreas; however, this well recognized phenomenon is incompletely understood because of the inconsistency of refusal rationales.…”

Section: Introductionmentioning

confidence: 99%

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Expanding the Pancreas Donor Pool

Fridell

Stratta

2014

Curr Transpl Rep

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Currently underutilized and in somewhat short supply, the pancreas allograft is a relatively scarce resource. Despite factors such as increased demand, positive changes in organ donation rates, and the liberalization of 'organ-acceptable' criteria, there has been a decline in the number of deceased donor pancreas transplants performed in the US. Concomitantly, there has been an increase in similar transplants performed in other countries. While it is understandable that there are a multiplicity of factors to be considered in the evaluation of the potential pancreas allograft donor in an attempt to minimize graft loss and morbidity, it is a simple truth that as a result there are unused transplantable organs. This paper will deal with the multifaceted problem of pancreas underutilization and will discuss strategies that could lead to the expansion of the pancreas donor pool.

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