title: Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization.
abstract: Pancreas allograft acceptance is markedly more selective than other solid organs. The number of pancreata recovered is insufficient to meet the demand for pancreas transplants (PTx), particularly for patients awaiting simultaneous kidney-pancreas (SPK) transplant. Development of a pancreas donor risk index (PDRI) to identify factors associated with an increased risk of allograft failure in the context of SPK, pancreas after kidney (PAK) or pancreas transplant alone (PTA), and to assess variation in allograft utilization by geography and center volume was undertaken. Retrospective analysis of all PTx performed from 2000 to 2006 (n = 9401) was performed using Cox regression controlling for donor and recipient characteristics. Ten donor variables and one transplant factor (ischemia time) were subsequently combined into the PDRI. Increased PDRI was associated with a significant, graded reduction in 1-year pancreas graft survival. Recipients of PTAs or PAKs whose organs came from donors with an elevated PDRI (1.57-2.11) experienced a lower rate of 1-year graft survival (77%) compared with SPK transplant recipients (88%). Pancreas allograft acceptance varied significantly by region particularly for PAK/PTA transplants (p < 0.0001). This analysis demonstrates the potential value of the PDRI to inform organ acceptance and potentially improve the utilization of higher risk organs in appropriate clinical settings.
authors.affiliation: Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH.
authors.forename: D A
authors.initials: DA
authors.lastname: Axelrod
authors.affiliation: Department of Surgery, University of Michigan, Ann Arbor, MI.|Arbor Research Collaborative for Health/Scientific Registry of Transplant Recipients, Ann Arbor, MI.
authors.forename: R S
authors.initials: RS
authors.lastname: Sung
authors.affiliation: Arbor Research Collaborative for Health/Scientific Registry of Transplant Recipients, Ann Arbor, MI.
authors.forename: K H
authors.initials: KH
authors.lastname: Meyer
authors.affiliation: Arbor Research Collaborative for Health/Scientific Registry of Transplant Recipients, Ann Arbor, MI.
authors.forename: R A
authors.initials: RA
authors.lastname: Wolfe
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: D B
authors.initials: DB
authors.lastname: Kaufman
mesh_terms: D005843:Geography; D006801:Humans; D016035:Pancreas Transplantation; D014184:Transplantation, Homologous; D016896:Treatment Outcome