Aim: Utilisation of DCD pancreas donation has been limited due to concern regarding warm ischemic injury leading to poor outcomes. The aims of the present work were to review our experience with donation after cardiac death pancreas donors to assess relevant contributing factors to success and potential for expansion.
Methods: We reviewed all recipients of pancreas grafts in our centre to identify those who had received grafts from donation after cardiac death donors. We then examined recipient and graft outcomes to ascertain success rates.
Results: We identified seven patients who had received pancreas grafts from donation after cardiac death donors between 2007 and 2015. All patients had received grafts in tandem with kidney transplantation, as part of simultaneous pancreas-kidney transplants. Donor factors were carefully selected with short warm ischemic times, limited cold ischemic times (CIT), low BMI and low age ranges. All donors were local, either from NSW or the nearby state of Victoria. Warm ischemic time was restricted to a mean of 17.4min (range 11-27min). CIT was limited with a mean of 11 hours and 58 minutes (range 7hrs 25min-19hrs 10min), with only one patient having a CIT greater than 13 hours. Donors tended to be in the younger age range of (mean=18.1) with low BMI (mean=23.9). Six out of seven donors did not experience hypotension, and none had hypertension. All recipients are insulin independent with good long-term graft function.
Conclusions: Despite concerns regarding the potential for ischemic injury using DCD successful graft outcomes using pancreata from DCD donors is possible with careful selection. Minimisation of the risk of ischemic injury is paramount to the success of DCD pancreas grafts and involves selection of younger donors from less distant hospitals to ensure reduction of cold ischemic times.