Outcomes of simultaneous pancreas–kidney transplantation from brain-dead and controlled circulatory death donors

Abstract

Abstract Background Organ scarcity has prompted increased use of organs from donation after circulatory death (DCD) donors. An early single-centre experience of simultaneous pancreas–kidney (SPK) transplantation from controlled DCD donors is described here. Methods Outcomes of SPK transplants from DCD and donation after brain death (DBD) donors between August 2008 and January 2011 were reviewed retrospectively. Results SPK transplants from 20 DCD and 40 DBD donors were carried out. Donor and recipient characteristics were similar for both groups, although pancreas cold ischaemia times were shorter in DCD recipients: median (range) 8·2 (5·9–10·5) versus 9·5 (3·8–12·5) h respectively (P = 0·004). Median time from treatment withdrawal to cold perfusion was 24 (range 16–110) min for DCD donors. There were no episodes of delayed pancreatic graft function in either group; the graft thrombosis rates were both 5 per cent. Similarly, there were no differences in haemoglobin A1c level at 12 months: median (range) 5·4 (4·9–7·7) per cent in DCD group versus 5·4 (4·1–6·2) per cent in DBD group (P = 0·910). Pancreas graft survival rates were not significantly different, with Kaplan–Meier 1-year survival estimates of 84 and 95 per cent respectively (P = 0·181). Conclusion DCD SPK grafts had comparable short-term outcomes to DBD grafts, even when procured from selected donors with a prolonged agonal phase.