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Abstract
BackgroundThe majority of pancreases, offered in allocation, are not transplanted. This pancreas under-utilisation is a phenomenon observed in all transplant systems in North-America and Europe. It was the aim of this study to analyse factors predictive of pancreas non-transplantation in Germany.MethodsRoutine Eurotransplant data of 3,666 deceased German donors (from 2002–2011) were used for multivariate modelling. Socio-demographic and medical factors were considered as independent variables in logistic regression models with non-transplantation as dependent variable.ResultsMale gender, advanced age, overweight/obesity, long ICU stay, a history of smoking, non-traumatic brain death, elevated levels of sodium, serum glucose, lipase/amylase and the liver not being considered for procurement were significant independent predictors of non-transplantation.ConclusionIn line with previous research, advanced age, high BMI, long ICU stay and the liver not being considered for procurement were the strongest predictors of pancreas non-transplantation in Germany. About three quarters of the variance remained unexplained, suggesting that factors not assessed or unknown may play a decisive role.
Highlights
The majority of pancreases, offered in allocation, are not transplanted
We excluded all donors with a positive test for Human Immunodeficiency Virus (HIV), since an HIV infection represents a general contraindication for pancreas donation. 3,666 donors aged 11–69 years were included
Principal findings In our analysis we identified several donor factors which were significantly associated with non-transplantation: increasing age, increasing ICU stay, overweight/obesity, liver not reported for procurement, history of smoking, male gender, a primarily non-traumatic cause of brain death and high levels of sodium, blood glucose, amylase and lipase
Summary
The majority of pancreases, offered in allocation, are not transplanted. This pancreas under-utilisation is a phenomenon observed in all transplant systems in North-America and Europe. It was the aim of this study to analyse factors predictive of pancreas non-transplantation in Germany. Methods: Routine Eurotransplant data of 3,666 deceased German donors (from 2002–2011) were used for multivariate modelling. Using routine data from ET we have previously analysed physician-reported refusal reasons to better understand why offered pancreases are refused in the allocation process [9]. A multitude of refusal reasons has been reported which were grouped in four domains: donor-related criteria, recipient-related criteria, logistic criteria and technical criteria. Other criteria were obviously less distinct: for instance, organs refused at least once for ‘trauma in donor’, ‘donor age’, or ‘resuscitation’ were later transplanted in 48%, 32%, and 28% of cases, respectively
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