Comparison of pancreas transplants from donors after cardiac death (DCD) and donors after brainstem death (DBD)

A. Rathnasamy Muthusamy¹, A. Vaidya¹, S. Sinha¹, I. Quiroga¹, E. Sharples², S. Reddy¹, J. Gilbert¹, P.J. Friend^3
1 Oxford Transplant Centre, Transplant Surgery, Oxford, U.K.; ² Oxford Transplant Centre, Transplant Nephrology, Oxford, U.K.; ³ University of Oxford, Oxford, U.K.

Objective: This article summarizes a single centre experience with transplantingpancreases from controlled DCD.

Method: From March ‘04 to February ‘11, 407 pancreas transplants wereperformed: 54 from DCD and 353 from DBD. DCD pancreases were accepted based ondonor age <60 years, BMI <32, and time to cardiac arrest from withdrawal<1 hour. Campath induction, Tacrolimus & MMF maintenance and TEGdirected anticoagulation were employed. Kaplan-Meier estimates were used tocompare 1-year graft & patient survival.

Results: There were 17 SPK, 22 PTA and 15 PAK from DCD; 282 SPK, 38 PAK and 33PTA from DBD, resulting in significantly more isolated pancreases (PAK &PTA) from DCD (p=0.0001). DCD had 14 months median follow-up (range 0-45); DBDhad 30 months’ follow up (range 0-83). DCD and DBD recipients were of similarage (43±9 vs. 42±8) and BMI (25±2.9 vs. 25±5). DCD donors were younger (33±12vs. 37±13, P=0.03) but had similar BMI as DBD (23±3vs. 24±4). DCD initial warmischemia was 13 minutes (0-21) and had longer cold ischemia (732±149 vs.663±167 minutes, p=0.01). DCD donors had less vascular cause of death (33% vs.52%, p=0.02). SPK pancreas survival and overall patient survival were similar(94% DCD vs. 89% DBD, p=0.5), (95% DBD vs. 96% DCD). Higher isolated DBDpancreas graft survival (89% DBD vs. 73% DCD, p=0.03) contributed to betteroverall DBD pancreas outcome (89 vs. 80%, p=0.04). DCD pancreas graft loss 2°to thrombosis was more frequent (11% vs. 0.8%, p=0.0008) despiteanticoagulation. DCD pancreases and associated kidneys had more frequent DGF(13% vs. 2%, p<0.0001) & (29% vs. 11%, p=0.02). PNF of the kidney (0%vs. 1%, P=NS) and of the pancreas (3.7% vs. 1.4%, P=NS) were similar.

These single-centre resultssuggest that DCD pancreases are better utilized if implanted simultaneouslywith a kidney.