Pancreas transplants from donors aged 45 years or older.
OBJECTIVE
Since donor age of 45 years or more is considered a relative contraindication for pancreas transplantation (PTx), we herein report our experience with these donors.


METHODS
Pancreases from donors aged 45 years or older were used in 16 of 147 PTx procedures (11%). The final decision to accept a graft for PTx was based mainly on the quality of visceral perfusion and the gross appearance of the pancreas and the vessels. There were 9 men and 7 women, ranging in age from 45 to 55 years (average, 48.9 years) who were donors, due to cerebrovascular accidents (n = 11; 68.7%). Among the donor group, 5 patients were receiving multiple vasopressor agents (31.2%), and 2 had a history of cardiac arrest (12.5%). Pancreases were transplanted either simultaneously with a cadaveric kidney (n = 6) or as solitary grafts (n = 10).


RESULTS
After a mean period of cold preservation of 616 minutes (range, 475 to 844 min), delayed endocrine function occurred in 1 recipient (6%), who subsequently achieved insulin independence. Two recipients died suddenly, with functioning grafts. Two further grafts were lost due to portal vein thrombosis (6%) or late arterial thrombosis (6%). Three patients required repeat surgery (18.7%). After a mean follow-up period of 26.6 months, actuarial 1-year and 5-year patient survival rates were 87.5%, with insulin independence in 81.2% and 67.7%, respectively.


CONCLUSIONS
Meticulous donor selection and short preservation times allow the safe use of pancreases procured from donors aged 45 years or older, thus expanding the donor pool for PTx procedures.
Boggi
U
U
Centro Regionale di Riferimento per La Cura delle Molattie del Pancreas, University of Pisa, Pisa, Italy.
Del Chiaro
M
M
Signori
S
S
Vistoli
F
F
Amorese
G
G
Croce
C
C
Morelli
L
L
Vanadia Bartolo
T
T
Pietrabissa
A
A
Barsotti
M
M
Rizzo
G
G
Mosca
F
F
D000367:Age Factors; D002102:Cadaver; D002423:Cause of Death; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000033:anatomy & histology*; D016035:Pancreas Transplantation / Q000401:mortality / Q000502:physiology*; D018579:Patient Selection; D011183:Postoperative Complications / Q000145:classification; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D020858:Tissue and Organ Harvesting / Q000379:methods