• Jonathan E H Ling, Shi Zhou Choo, Kevan R Polkinghorne, and John Kanellis.
• Department of Nephrology, Monash Health, Melbourne, Victoria, Australia.
• Intern Med J. 2022 Sep 1; 52 (9): 1569-1586.

BackgroundIncreased recipient and donor age are associated with worse solid organ pancreas transplant outcomes. However, donor and recipient age criteria vary between jurisdictions. We systematically reviewed studies reporting the association between transplanting older recipients and donors beyond current Transplantation Society of Australia and New Zealand (TSANZ) limits with solid pancreas transplant outcomes.AimsTo review current outcomes of solid pancreas transplantation in recipients and donors over the TSANZ reference ages.MethodsStudies comparing transplant outcomes between a reference-age and an older-age donor (>45 years) or recipient (≥50 years) cohort for solid pancreas transplantation were included. Primary outcomes were pancreas/kidney graft and patient survival at 1 and 5 years. Secondary outcomes were post-transplant complications (graft thrombosis, acute rejection and relaparotomy rates).ResultsEleven studies were included (two studies assessing solid pancreas outcomes between older vs reference-aged donors and nine studies assessing outcomes between older vs reference-aged recipients). Seven of 11 studies were judged to be at high risk of bias. Primary and secondary outcomes were not significantly different between recipient age groups in nine studies. A sensitivity analysis of older versus reference-aged studies excluding studies at high risk of bias also showed non-inferior primary and secondary outcomes at 1 year. Two studies comparing outcomes by donor age showed worse graft survival but non-inferior patient survival with older donors.ConclusionIncreased donor or recipient age alone should not absolutely contraindicate solid pancreas transplantation, especially if other risk predictors are minimised.© 2021 Royal Australasian College of Physicians.

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