Table 1.
Studies comparing pancreas transplant outcomes between donations after cardiac death vs donation after brain death pancreas allograft recipients
| First author/ yr | Country | Type of study | No. transplants | Mean donor age (yr) | Donor BMI [Median, IQR] | Warm ischemia time (min) | Cold ischemia time (hours) | Follow-up (yr) | Comments/conclusions |
| D’Alessandro et al[41], 2004 | United States | Cohort | 31 DCD; 455 DBD | Unclear | ns | 15.3 (SD ns) | 15.9 (SD ns) | 5 | No difference in 5-yr graft survival in SPKs |
| Fernandez et al[43], 2005 | United States | Cohort | 37 DCD; 539 DBD | 31 | ns | 17.5 (SD = 9.9) | 15.8 (SD = 3.4) | 5 | Indistinguishable patient and graft 5-yr survival in SPKs. Elevated DGF rate on DCD kidneys, with no significant long-term impact. |
| Salvalaggio et al[44], 2006 | United States | Cohort; OPTN/UNOS Registry | 57 DCD; 3948 DBD | DCD= 30.1; DBD = 29 | ns | ns | 15.7 | 5 | For SPK recipients, the wait for DCD organs was shorter. DCD SPK recipients had longer hospital stay. Renal DGF was higher with DCD organs. Higher thrombosis rates (12.8% vs 6.1%) |
| Bellingham et al[42], 2011 | United States | Cohort | 72 DCD; 903 DBD | DCD= 30 | ns | 20.8 (SD = 9.4) | ns | 10 | No difference in surgical complications, rejection or hemoglobin A1c levels. |
| Muthusamy et al[45], 2012 | United Kingdom | Cohort | 134 DCD; 875 DBD | DBD = 32; DCD= 28 | 23 | 12 | 12.5 | 1 | Similar patient and graft survival, with improved DCD pancreas graft survival if performed as an SPK. Early graft loss in the DCD cohort was mainly due to thrombosis (8% vs 4%) |
| Shahrestani et al[46], 2017 | Australia | Systematic review and meta-analysis | 762 DCD; 23609 DBD (included 10 cohort studies and 8 case reports) | DBD = 37 ns | 21-25 ns | ns | ns | 0.3-15 | No significant difference in 10-yr graft or patient survival. Higher graft thrombosis risk with DCDs [95%CI: 1.04-2.67; P = 0.006]. Thrombosis risk not higher when DCD donors were given ante-mortem heparin (P = 0.62) |
| Kopp et al[39], 2018 | The Netherlands | Cohort | 21 DCD; 83 DBD | a | a | 31 (median) | 11 (median) | 5 | Without the DCD factor, PDRI from DCD donors was lower. Donor age was the only donor-related risk factor associated with graft survival. Post-op bleeding and renal DGF were more common with DCDs. Graft survivals were comparable. DCD pancreata had lower thrombosis incidence. DCD donors yield similar outcomes for low PDRI. Most DCD donors were younger. DCD grafts may be a better option rather than older DBD donors. |
a
Range not significantly different between DCD vs DBD donors. BMI: Body mass index; SD: Standard deviation; ns: Not stated in the study; DCD: Donation after cardiac death; DBD: Donation after brain death; SPK: Simultaneous kidney-pancreas transplant; DGF: Delayed graft function; PDRI: Pancreas donor risk index.