Thursday 14 march 2019
13:06 - 13:09h
Categories: Klinisch, Postersessie
Parallel session: Postersessies 6 - Clinical
J.W. Mensink1, K.M. Ooms - de Vries2, V.A.L. Huurman1, R.A. Pol3, I.P.J. Alwayn1, A.E. Braat1.
1Dept. of Surgery, Division of Transplantation, Leiden University Medical Center, Leiden. 2Dept. of Quality, Dutch Transplant Foundation, Leiden. 3Dept. of Surgery, Division of Transplantation, University Medical Center Groningen, Groningen,The Netherlands.
Background: The discrepancy between the number of patients on the waiting list and the number of donor pancreata for transplantation needs extension of accepting criteria for pancreas allografts. We investigated ways to safely increase the number of suitable pancreas allografts by expanding donor BMI and age criteria.
Methods: The current pancreas donor selection in the Netherlands was analysed and compared to the potential pancreas donors if extended criteria donors would have been used. Risk assessment was done by in-depth analysis of all donor reports and calculation of the PDRI. An additional method to approach a more adequate number of potential donors in extended age criteria was to select donors without Diabetes Mellitus, BMI <30 kg/m2and who donated their liver and at least one kidney, suggesting to have a general medical condition being sufficient to potentially also donate their pancreas.
Results: Between January 1st2014 and December 31st2017, 405 of 1273 donors were reported as potential whole pancreas donor. Of these 405 reported donors 93 (23%) pancreata were eventually transplanted as whole organ. Extending BMI criteria up to BMI ≤35 kg/m2results in an 6% increase of pancreas donors reported. If age criteria would be increased by 5 years, it could result in an additional 21% potential DBD donors and 53% potential DCD donors reported. The PDRI of these extended criteria donors was in 31% of the cases below the upper limit of currently accepted and transplanted pancreas allografts. In respectively 45% and 64% of all potential DBD and DCD donors no absolute contra-indications were found by in-depth analysis of the donor report.
Conclusions: Selected older donors have similar risk parameters as compared to current pancreas donors, except for age itself. The PDRI seems not to reflect the actual increased risk in higher aged donors. It demands validation and adjustment for these extended criteria donors. Expanding BMI criteria does not result in a significant increase of potential donor pancreata. However, by extending age criteria, this study shows an acceptable risk predictive strategy to optimize pancreas donor selection and to meet the increasing waiting list.