title: The allocation of pancreas allografts on donor age and duration of intensive care unit stay: the experience of the North Italy Transplant program.
abstract: Starting in 2011, the North Italy Transplant program (NITp) has based on the allocation of pancreas allografts on donor age and duration of intensive care unit (ICU) stay, but not on donor weight or BMI. We analyzed the detailed allocation protocols of all NITp pancreas donors (2011-2012; n = 433). Outcome measures included donor characteristics and pancreas loss reasons during the allocation process. Twenty-three percent of the 433 pancreases offered for allocation were transplanted. Younger age, shorter ICU stay, traumatic brain death, and higher eGFR were predictors of pancreas transplant, either as vascularized organ or as islets. Among pancreas allografts offered to vascularized organ programs, 35% were indeed transplanted, and younger donor age was the only predictor of transplant. The most common reasons for pancreas withdrawal from the allocation process were donor-related factors. Among pancreas offered to islet programs, 48% were processed, but only 14.2% were indeed transplanted, with unsuccessful isolation being the most common reason for pancreas loss. Younger donor age and higher BMI were predictors of islet allograft transplant. The current allocation strategy has allowed an equal distribution of pancreas allografts between programs for either vascularized organ or islet transplant. The high rate of discarded organs remained an unresolved issue.
authors: Immunology Unit, North Italy Transplant Inter-Regional Reference Center Organ and Tissue Transplantation, IRCCS Policlinico Maggiore Hospital, Milano, Italy.
authors: Massimo
authors: M
authors: Cardillo
authors: Rita
authors: R
authors: Nano
authors: Nicola
authors: N
authors: de Fazio
authors: Raffaella
authors: R
authors: Melzi
authors: Francesca
authors: F
authors: Drago
authors: Alessia
authors: A
authors: Mercalli
authors: Antonio
authors: A
authors: Dell'Acqua
authors: Marina
authors: M
authors: Scavini
authors: Lorenzo
authors: L
authors: Piemonti
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D016381:Islets of Langerhans Transplantation / Q000706:statistics & numerical data / Q000639:trends; D007558:Italy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000706:statistics & numerical data / Q000639:trends; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration / Q000706:statistics & numerical data; D055815:Young Adult
keywords: islet transplantation; organ allocation; organ donors; pancreas transplantation