Donor pancreata: evolving approaches to organ allocation for whole pancreas versus islet transplantation.
As islet transplantation increasingly enters the clinical arena, its coexistence with vascularized pancreas transplantation makes it necessary to reassess the questions of donor selection and allocation. In answering these questions, one must put in the balance the short-term morbidity of pancreas transplantation with the long-term attrition of islet grafts. The preferential allocation of pancreases from obese and older donors for islet isolation has been based on their association with worse pancreas transplant outcomes and better islet isolation results in islet yields. In this overview, we show that transplanted islet mass does not necessarily correlate with graft function and make the case that donor selection criteria for islet transplantation, and hence allocation rules, may need to be redefined.
Berney
Thierry
T
Department of Surgery, Cell Isolation and Transplantation Center, Geneva University Hospitals and University of Geneva School of Medicine, Geneva, Switzerland. thierry.berney@hcuge.ch
Johnson
Paul R V
PR
D000367:Age Factors; D015992:Body Mass Index; D046148:Donor Selection; D006085:Graft Survival; D015276:Health Care Rationing; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects; D016035:Pancreas Transplantation / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome