Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 28, 2020; 10(12): 372-380
Published online Dec 28, 2020. doi: 10.5500/wjt.v10.i12.372
Donor risk factors in pancreas transplantation
Luis Muñoz-Bellvís, Jaime López-Sánchez
Luis Muñoz-Bellvís, Jaime López-Sánchez, Department of General & Gastrointestinal Surgery, Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca 37007, Spain
Luis Muñoz-Bellvís, Jaime López-Sánchez, Salamanca Biomedical Research Institute (IBSAL), Universidad de Salamanca, Salamanca 37007, Spain
Author contributions: Muñoz-Bellvís L and López-Sánchez J performed and wrote the manuscript; All authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Luis Muñoz-Bellvís, MD, Doctor, Professor, Surgeon, Department of General & Gastrointestinal Surgery, Hospital Universitario de Salamanca, Universidad de Salamanca, Paseo de San Vicente 158, Salamanca 37007, Spain.
Received: June 20, 2020
Peer-review started: June 20, 2020
First decision: August 22, 2020
Revised: August 29, 2020
Accepted: October 9, 2020
Article in press: October 9, 2020
Published online: December 28, 2020

The aim of the work was to analyze and expose the donor and recipient risk factors in pancreas transplantation. In the following paper, we exposed the 2018 Spanish Consensus Document on Donor and Recipient Selection Criteria for Pancreas Transplantation. An assessment of the previous Selection Criteria for Donors and Recipients of Pancreas Transplantation, published in 2005 by the Spanish Pancreas Transplant Group (GETP) and the National Transplant Organization (ONT) was performed. A literature review was performed using Cochrane Library, PubMed and Google Scholar databases. Some of the following terms were used for the literature search: “Diabetes Mellitus,” “Pancreas Transplantation,” “Insulin-Secreting Cells,” “Pancreas Allograft Thrombosis,” “Allograft Pancreatitis,” “Donors’ Risk Factors,” “Recipients’ Risk Factors,” “Pancreas Allograft Rejection” and “Pancreas Allograft Survival.” After an extended search, different inclusion criteria were established. Articles and documents with abstracts of full text and in English or Spanish language were selected. Subsequently, different scientific meetings took place during 2015 and 2016 by the GETP. Finally, the updated criteria were published by the GETP and ONT in 2018. Several risk factors have been described in pancreas transplantation that can be divided into donor risk factors: Advanced age (> 50 years); high body mass index (BMI) (> 30 kg/m2); cause of death (e.g., stroke); previous hyperglycemia; hyperamylasemia; cold ischemia time (greater than 8 or 12 h, depending on the type of donation); the use of vasopressors in the intensive care unit or cardiac arrest; and the macroscopic aspect of the pancreas allograft. The following are recipient risk factors: Advanced age (> 50 years); active smoking; high BMI (> 30 kg/m2); and peripheral artery disease or sensorimotor polyneuropathy. Based on the aforementioned parameters, different selection criteria have been established for the recipients depending on the type of pancreas transplantation. Knowledge of the risk factors for pancreas transplantation allows the establishment of reliable selection criteria for choosing donors and recipients.

Keywords: Pancreas transplantation, Pancreas donor, Pancreas recipient, Diabetes mellitus, Risk factors, Graft rejection

Core Tip: Pancreas transplantation remains the only treatment to restore euglycemia and hemoglobin A1c levels in diabetic patients. However, it presents high morbidity due to different postoperative complications and the effects of the immunosuppressive therapies. The pancreas transplantation complications occur more frequently in specific cases related to donor factors (high body mass index, older age, etc.). Several studies analyzed the donor and recipient risk factors. Knowing these risk factors allows us to establish specific selection criteria in pancreas transplantation and may improve its results.