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Presenter: A., Rathnasamy Muthusamy, Oxford, U.K
Authors: A. Rathnasamy Muthusamy, A. Vaidya, S. Sinha, I. Quiroga, E. Sharples, S. Reddy, J. Gilbert, P.J. Friend
Comparison of pancreas transplants from donors after cardiac death (DCD) and donors after brainstem death (DBD)
A. Rathnasamy Muthusamy1, A. Vaidya1, S. Sinha1, I. Quiroga1, E. Sharples2, S. Reddy1, J. Gilbert1, P.J. Friend3
1 Oxford Transplant Centre, Transplant Surgery, Oxford, U.K.; 2 Oxford Transplant Centre, Transplant Nephrology, Oxford, U.K.; 3 University of Oxford, Oxford, U.K.
Objective: This article summarizes a single centre experience with transplantingpancreases from controlled DCD.
Method: From March ‘04 to February ‘11, 407 pancreas transplants wereperformed: 54 from DCD and 353 from DBD. DCD pancreases were accepted based ondonor age <60 years, BMI <32, and time to cardiac arrest from withdrawal<1 hour. Campath induction, Tacrolimus & MMF maintenance and TEGdirected anticoagulation were employed. Kaplan-Meier estimates were used tocompare 1-year graft & patient survival.
Results: There were 17 SPK, 22 PTA and 15 PAK from DCD; 282 SPK, 38 PAK and 33PTA from DBD, resulting in significantly more isolated pancreases (PAK &PTA) from DCD (p=0.0001). DCD had 14 months median follow-up (range 0-45); DBDhad 30 months’ follow up (range 0-83). DCD and DBD recipients were of similarage (43±9 vs. 42±8) and BMI (25±2.9 vs. 25±5). DCD donors were younger (33±12vs. 37±13, P=0.03) but had similar BMI as DBD (23±3vs. 24±4). DCD initial warmischemia was 13 minutes (0-21) and had longer cold ischemia (732±149 vs.663±167 minutes, p=0.01). DCD donors had less vascular cause of death (33% vs.52%, p=0.02). SPK pancreas survival and overall patient survival were similar(94% DCD vs. 89% DBD, p=0.5), (95% DBD vs. 96% DCD). Higher isolated DBDpancreas graft survival (89% DBD vs. 73% DCD, p=0.03) contributed to betteroverall DBD pancreas outcome (89 vs. 80%, p=0.04). DCD pancreas graft loss 2°to thrombosis was more frequent (11% vs. 0.8%, p=0.0008) despiteanticoagulation. DCD pancreases and associated kidneys had more frequent DGF(13% vs. 2%, p<0.0001) & (29% vs. 11%, p=0.02). PNF of the kidney (0%vs. 1%, P=NS) and of the pancreas (3.7% vs. 1.4%, P=NS) were similar.
These single-centre resultssuggest that DCD pancreases are better utilized if implanted simultaneouslywith a kidney.
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