306.6: Importing Pancreata for Transplantation: An 18-year Single Center Experience

Abstract

Introduction: Pancreatic Transplant (PTX) is a safe surgical procedure offered to diabetic patients with or without chronic kidney disease. With the new allocation system in the US, more pancreas offers are coming from beyond one’s donor service area (DSA), and region. Whether transplanting grafts from beyond one’s DSA or region is a safe practice is unknown. In this study, we analyzed our experience with importing pancreata according to DSA and UNOS region source and distance from the donor hospital to the transplant center, resembling the newest changes mandated by UNOS allocation policies. Methods: We analyzed primary PTXs performed between January 2000 and December 2018. Recipients of simultaneous pancreas and kidney (SPK), primary solitary pancreas (PAN) including pancreas after kidney (PAK) and pancreas transplant alone (PTA) transplants were analyzed. Two separate analyses were performed: i) based on graft origin (local, regional and national) and ii) based on nautical mile (NM) distances form the (< 250 NM, 250 and 750 NM and > 750 NM) which were retrospectively determined. Primary outcome was DC-graft survival (DC-GS), overall and stratified by transplant type and geographical source. DC-GS survival was analyzed using Kaplan-Meier analyses. All grafts were enterically drained with systemic venous drainage. Results: There were 884 PTXs; 676 underwent SPK and 208 PAN. Of these, 152 underwent PTA and 56 PAK. Donor PDRI and recipient baseline characteristics were similar between groups. Evaluating all PTX together, we observed no statistical differences in the DC-GS based on local, regional or national organ source; nor did we see a difference based on NM distance. Analyzing by graft origin (local vs regional vs national): the 5-year DC-GS rates for SPK were similar at 83% vs 83% vs 85% (p=0.50) and the 5-year DC-GS rates for PAN were 82% vs 64% vs 75% (p=0.17). The 5-year DC-GS rates were also similar across locales for both PTA (83% vs 60% vs 77%; p=0.14) and PAK (78% vs 73% vs 69%; p=0.55). Based on the NM distance from donor to transplant hospital (<250NM, 250-750NM and >750NM): the 5-year DC-GS rates for SPK were similar across distances at 83% vs 84% vs 89% (p=0.69). The 5-year DC-GS rates for PAN were not different from one another at 73% vs 72% vs 78% (p=0.96). The 5-year DC-GS rates across distances for PTA (71% vs 73% vs 81%; p=0.79) and PAK (76% vs 70% vs 67%; p=0.65) were not statistically different from one another. Conclusions: With greater sharing mandated by new UNOS allocation policies, we aim to demonstrate the utility of importing selected pancreata from non-local regions and DSAs and from > 250NM from the transplant center. This experience emphasizes the possibility of importing pancreatic grafts to increase organ utilization, increase center transplant rates and reduce waiting times for patients.