Donor pool for pancreas transplantation grows with cardiac death donors

Last Updated: 2016-03-30

By Marilynn Larkin

NEW YORK (Reuters Health) - Donation after cardiac death (DCD) is a "viable alternative" to donation after brain death (DBD) for pancreas transplantation, researchers from Australia report.

Pancreas transplantation is "the gold standard for the treatment of type 1 diabetes because it results in a long-term, insulin-independent, normoglycemic state," according to the researchers. Yet patients with diabetes on the transplant list have a two-year waitlist mortality of 17% and a three-year waitlist mortality of 27%, in part because of the scarcity of donors. To increase the potential donor pool, which is made up largely of DBD, DCDs are increasingly being used.

To compare recipient outcomes from DCD versus DBD donors, the researchers undertook a systematic review and meta-analysis by searching several large databases for studies reporting the outcomes of DCD pancreas transplants. They identified 18 studies, eight of which included a DBD comparison group comprising 23,609 transplant recipients.

There was no significant difference in allograft survival up to 10 years (hazard ratio 0.98) or patient survival (HR 1.31) between DCD and DBD pancreas transplants, the authors reported in an article online March 4 in Transplantation.

The estimated odds of graft thrombosis came to 1.67 times higher in DCD organs; however, a subgroup analysis found thrombosis was not higher in recipients whose DCD donors were given antemortem heparin.

The study authors concluded that "using current DCD criteria, pancreas transplantation is a viable alternative to DBD transplantation, and antemortem interventions including heparinization may be beneficial."

Senior author Dr. Wayne Hawthorne of the Centre for Transplant and Renal Research at Westmead Millennium Institute in New South Wales, told Reuters Health by email that the Australian government recently implemented an organ donor awareness campaign that also increased potential organ donation utilization rates.

As a result of these efforts, "there has been a significant increase in the number of DCD organs for transplantation," Dr. Hawthorne said. "Our Simultaneous Pancreas and Kidney (SPK) Transplant program had not previously utilized DCD for SPK transplants and so we wanted to ensure that we investigated this before we commenced using DCD pancreases, as we were concerned they may have an effect on our transplant outcomes."

"We had read that some large studies comparing pancreas transplants from DCD and DBD donors demonstrated similar patient survival and allograft survival across these groups and similar rates of allograft survival at 10 years. But we wanted to ensure that we had reviewed all the data before embarking on a clinical program utilizing DCD for SPK transplants," he said.

Dr. Hawthorne added, "Our study clearly shows that DCD pancreas transplantation is a feasible option . . . for SPK transplants (and) can widen potential access to more donor organs for transplants, which is fantastic for patients on the waiting list. Future studies will assist in clarifying means of optimizing more positive outcomes from this type of donor, such as further investigating selection criteria such as age and the use of antemortem heparin."

Dr. David Sutherland, of the University of Minnesota in Minneapolis and a pioneer in pancreas transplantation, congratulated the study authors on a "thorough review" and for "sorting out the nuances that affect pancreas graft survival from DCD donors," and noted that "the finding that antemortem heparin administration reduces the pancreas transplant thrombosis rate in grafts from DCD donors is very important."

"I think the article will stimulate an increase in use of DCD donors for pancreas transplantation, given the good outcomes," Dr. Sutherland concluded.

The Westmead Medical Research Foundation supported this research. The authors made no disclosures.

SOURCE: http://bit.ly/1Utd7b3

Transplantation 2016.