Solid pancreas transplant: Pushing forward

Table 2 Studies on the effect of pancreas procurement professionalization and center volume on pancreas transplant outcomes

First author, yr	Study aim	Region, country	Study period	No. cases	Results/comments
Boer et al[49], 2017	Analysis of abdominal organ procurement quality and clinical impact.	Eurotransplant, The Netherlands	2012-2013	591 procurements	13% surgical injuries on procured pancreata, leading to 3% pancreas discards. Higher BMI, DCD donation in liver procurement were risk factors for discard due to injury. High procurement volume centers were associated with less pancreatic injury.
Lam et al[50], 2017	Analysis on the effect of the abdominal recovery team professionalization on the pancreatic procurement injury and acceptance for transplant.	Eurotransplant, The Netherlands	2002-2015	264 procurements	31.8% pancreatic surgical injuries. 85.6% of procured pancreata were eventually transplanted. Surgeons certified in abdominal organ procurements recovered more grafts from older donors, DCDs, and had less surgical injuries. Predictors to proceed with pancreas transplant were: certified procurement surgeons; surgeons from a pancreas transplant center; DBD donation; and lower donor BMI. Procurement certification results in less surgical damage and more pancreata transplanted.
Kopp et al[52], 2017	Analysis of the effect of the transplant center volume on pancreas transplant outcomes.	Eurotransplant, The Netherlands	2008-2013	1276 pancreas transplants	Centers were classified into: low (< 5 transplants/yr); medium (5-13/yr); high volume (≥ 13/yr). Patient and graft survival were superior in higher volume centers. High center volumes were protective for graft failure, even though they transplanted organs with higher PDRI.
Alhamad et al[53], 2017	Analysis of the effect of the transplant center volume on the pancreas allograft failure risk.	UNOS, United States	2000-2013	11568 SPKs and 4308 solitary pancreas transplants	Centers were categorized into low, medium, and high tertiles. Low volume centers were associated with higher pancreatic failure risk. High volume centers had better graft survival rates irrespective of PDRI.

BMI: Body mass index; DCD: Donation after cardiac death; DBD: Donation after brain death; PDRI: Pancreas donor risk index; SPKs: Simultaneous kidney-pancreas transplants.