Simultaneous Pancreas -Kidney Transplantation Using Organs from Donors after Circulatory Death

Abstract

Introduction: Organs from donation after circulatory death (DCD) donor are increasingly being used to expand the donor pool. What are the outcomes of simultaneous pancreas-kidney transplants (SPKTx) utlizing DCD donors? Methods: A single centre, retrospective study was performed of 129 consecutive systemic-enteric drained SPKTx performed from 18/2/2006 to 10/10/2011. The SPKTx from DCD (n=15) were compared to DBD organs (n=114). The median follow-up was significantly shorter in the DCD group compared to the donation after brain death (DBD) group (17 months vs. 40 months). Therefore, actuarial survival analysis was done, and 2 year outcomes are reported. Results: DCD donors had a greater proportion whose cause of death was trauma (57% DCD vs. 22% DBD, p=0.005), and DCD donors were younger compared to the DBD donors (mean age 29 yrs DCD vs. 34 yrs DBD, p=0.1). Other donor, recipient and transplant characteristics compared were similar between the 2 groups. There was no significant difference between the 2 groups in the 2 year actuarial patient survival (100% DCD vs. 97% DBD), death-censored pancreas survival (91% DCD vs. 92% DBD), and death-censored kidney allograft survival (96% vs. 100%, all p=NS). The rates of kidney delayed graft function were similar (27% DCD vs. 25% DBD, p=NS). Analysis of other outcomes showed no significant difference in the incidence of 1st year biopsy-proven acute rejections (27% each), peripancreatic fluid collections (27% DCD vs. 18% DBD), pancreatic fistula (12% each), proven duodenal stump leak (0 DCD vs. 4% DBD), graft pancreatitis (27% DCDvs. 36% DBD), graft thrombosis (0 DCD vs. 2% DBD) and major bleeding (7% each). Although the overall infection rates were similar (67% DCD vs. 56% DCD), there was slightly higher incidence of intra-abdominal sepsis (27% DCD vs. 12% DBD, p=0.1) in the DCD group. Further analysis showed that all cases of the intra-abdominal sepsis in the DCD group were peripancreatic fluid collections that were infected. There was no obvious duodenal stump leak in any of these 4 collections. Conclusion: The outcomes of DCD SPKTx were seen to be excellent, and comparable with the DBD transplants. There was a slightly increased incidence of infected intraabdominal collections in the DCD group, which could possibly be related to contamination from the rapid process involved in the DCD organ retrieval. However, our numbers are small, and would benefit from a larger series analysis for a definite conclusion.