• Pancreatology · Jan 2017

    Review Meta Analysis Comparative Study

    Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death.

    • Ellen S van Loo, Christina Krikke, Hendrik S Hofker, Stefan P Berger, Henri G D Leuvenink, and Robert A Pol.
    • Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: esvanloo@home.nl.
    • Pancreatology. 2017 Jan 1; 17 (1): 13-18.

    IntroductionTo overcome the gap of organ shortage grafts from donation after circulatory death (DCD) can be used. This review evaluates the outcomes after DCD pancreas donation compared to donation after brain death (DBD).Materials And MethodsA literature search was performed using Medline, Embase, and PubMed databases. All comparative cohort studies reporting the outcome after DCD and DBD pancreas transplantation were included. All data were assessed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. To evaluate the event rates, pooled odds ratios (ORs) as well as the 95% confidence intervals (CI) were calculated. Since the number of studies is small we used the random-effects model only to overcome heterogeneity.ResultsThere is no difference in 1-year pancreas graft survival (OR 1.092, CI 95% 0.649-1.837, P = 0.741) or patient survival (OR 0.699, CI 95% 0.246-1.985, P = 0.502). Simultaneous pancreas-kidney (SPK) transplantation showed significantly higher graft survival rates compared to pancreas transplantation alone (87.2% vs. 76.6%, P < 0.001 in DBD and 86.5% vs. 74.9%, P < 0.001 in DCD). DCD SPK grafts show a higher delayed kidney graft function rate compared to DBD SPK-grafts (OR 0.209, CI 95% 0.104-0.421, P < 0.001). There is significantly less pancreas graft thrombosis after DBD-donation (OR 0.567, CI 95% 0.340-0.946, P = 0.030). We found no difference in the HbA1c level at 1-year follow-up with a median of 5.4% in both groups and a mean of 5.63% (DCD) vs 5.43% (DBD).DiscussionDCD pancreas transplantation has comparable patient and 1-year graft survival rates and should be considered a safe alternative for DBD pancreas transplantation.Copyright © 2016 IAP and EPC. Published by Elsevier B.V. All rights reserved.

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