Solid pancreas transplant: Pushing forward

Table 1 Studies comparing pancreas transplant outcomes between donations after cardiac death vs donation after brain death pancreas allograft recipients

First author/ yr	Country	Type of study	No. transplants	Mean donor age (yr)	Donor BMI [Median, IQR]	Warm ischemia time (min)	Cold ischemia time (hours)	Follow-up (yr)	Comments/conclusions
D’Alessandro et al[41], 2004	United States	Cohort	31 DCD; 455 DBD	Unclear	ns	15.3 (SD ns)	15.9 (SD ns)	5	No difference in 5-yr graft survival in SPKs
Fernandez et al[43], 2005	United States	Cohort	37 DCD; 539 DBD	31	ns	17.5 (SD = 9.9)	15.8 (SD = 3.4)	5	Indistinguishable patient and graft 5-yr survival in SPKs. Elevated DGF rate on DCD kidneys, with no significant long-term impact.
Salvalaggio et al[44], 2006	United States	Cohort; OPTN/UNOS Registry	57 DCD; 3948 DBD	DCD= 30.1; DBD = 29	ns	ns	15.7	5	For SPK recipients, the wait for DCD organs was shorter. DCD SPK recipients had longer hospital stay. Renal DGF was higher with DCD organs. Higher thrombosis rates (12.8% vs 6.1%)
Bellingham et al[42], 2011	United States	Cohort	72 DCD; 903 DBD	DCD= 30	ns	20.8 (SD = 9.4)	ns	10	No difference in surgical complications, rejection or hemoglobin A1c levels.
Muthusamy et al[45], 2012	United Kingdom	Cohort	134 DCD; 875 DBD	DBD = 32; DCD= 28	23	12	12.5	1	Similar patient and graft survival, with improved DCD pancreas graft survival if performed as an SPK. Early graft loss in the DCD cohort was mainly due to thrombosis (8% vs 4%)
Shahrestani et al[46], 2017	Australia	Systematic review and meta-analysis	762 DCD; 23609 DBD (included 10 cohort studies and 8 case reports)	DBD = 37 ns	21-25 ns	ns	ns	0.3-15	No significant difference in 10-yr graft or patient survival. Higher graft thrombosis risk with DCDs [95%CI: 1.04-2.67; P = 0.006]. Thrombosis risk not higher when DCD donors were given ante-mortem heparin (P = 0.62)
Kopp et al[39], 2018	The Netherlands	Cohort	21 DCD; 83 DBD	a	a	31 (median)	11 (median)	5	Without the DCD factor, PDRI from DCD donors was lower. Donor age was the only donor-related risk factor associated with graft survival. Post-op bleeding and renal DGF were more common with DCDs. Graft survivals were comparable. DCD pancreata had lower thrombosis incidence. DCD donors yield similar outcomes for low PDRI. Most DCD donors were younger. DCD grafts may be a better option rather than older DBD donors.

^aRange not significantly different between DCD vs DBD donors. BMI: Body mass index; SD: Standard deviation; ns: Not stated in the study; DCD: Donation after cardiac death; DBD: Donation after brain death; SPK: Simultaneous kidney-pancreas transplant; DGF: Delayed graft function; PDRI: Pancreas donor risk index.