Simultaneous Pancreas-Kidney Transplantation From Donation After Cardiac Death: Successful Long-term Outcomes

The lengthening waiting lists caused by the shortage of available organs and the increasing number of patients with end-stage organ disease have led to the search for new sources of transplantable organs. It has been suggested that, with the current standards of practice, the pancreas is the least likely abdominal organ to be deemed suitable for transplantation.1 Waiting list times for simultaneous pancreas-kidney (SPK) transplantation are increasing. At the end of 1993, there were 855 patients awaiting SPK transplantation, whereas at the end of 2002 there were 2425 (Organ Procurement and Transplantation Network, OPTN). For this reason, attempts to maximize pancreas utilization to satisfy demands is a problem of increasing significance. Alternatives, including the use of less-than-ideal donors,1 living donors,2–4 and pediatric donors,5 have been used in an attempt to expand the donor pool. Another approach to expanding the donor pool for pancreas transplantation is to use pancreata from donation after cardiac death (DCD). While the use of kidneys and livers from DCD donors is increasing, the use of DCD pancreata is still low (UNOS). DCD is not a novel concept. Prior to the institution of brain death laws in the United States, all donors were DCD donors. Pancreas procurement from DCD donors was described for the first time in 1975.6 However, routine implementation of DCD recovery at many centers has been impeded by ethical concerns, logistical considerations, and fear of poor functional outcomes. Recent studies have shown that DCD renal transplantation can result in outcomes similar to those obtained with kidneys from donation after brain death (DBD) donors.7,8 Experience with DCD liver transplantation is promising but has demonstrated an increased rate of biliary complications as well as a decrease in patient and graft survival.9–11 Limited experience with DCD pancreas transplantation is available, and this is primarily short-term follow-up in a small number of patients.12,13 This report describes the largest single-center experience, with 37 consecutive DCD SPK transplants since the inception of an extrarenal DCD donor program in January 1993, and provides the first data on long-term functional outcomes. In comparison to a contemporaneous cohort of recipients of conventional DBD organs, SPK transplantation from selected DCD donors resulted in similar excellent patient, kidney, and pancreas graft survival.