A registry analysis of damage to the deceased donor pancreas during procurement.
Surgical injury to the pancreas is thought to occur commonly during procurement. The UK Transplant Registry was analyzed to determine the frequency of pancreatic injuries, identify factors associated with damage, and assess the impact of injuries on graft survival. Twelve hundred ninety-six pancreata were procured from donation after brain death donors, with 314 (19.5%) from donation after circulatory death donors. More than 50% of recovered pancreata had at least one injury, most commonly a short portal vein (21.5%). Liver donation, procurement team origin, hepatic artery (HA) arising from the superior mesenteric artery (SMA), and increasing donor BMI were associated with increased rates of pancreas damage on univariate analyses; on multivariate analysis only the presence of an HA from the SMA remained significant (p = 0.02). Six hundred forty solid organ pancreas transplants were performed; 238 had some form of damage. Overall, there was no difference in graft survival between damaged and undamaged organs (p = 0.28); however, graft loss was significantly more frequent in pancreata with arterial damage (p = 0.04) and in those with parenchymal damage (p = 0.05). Damage to the pancreas during organ recovery is more common than other organs, and meticulous surgical technique and awareness of damage risk factors are essential to reduce rates of procurement-related injuries.
HPB Surgery, Hospital Xeral, Vigo, Spain.
F
F
Ausania
Department of Nephrology and Transplantation, Guy's Hospital, London, UK.
M
M
Drage
HPB and Transplant Surgery, Freeman Hospital, Newcastle, UK.
D
D
Manas
Department of Nephrology and Transplantation, Guy's Hospital, London, UK.
C J
CJ
Callaghan
D000293:Adolescent; D000328:Adult; D001926:Brain Death; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010179:Pancreas / Q000293:injuries*; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods; D010180:Pancreatectomy / Q000009:adverse effects* / Q000379:methods; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome; D006113:United Kingdom; D055815:Young Adult
clinical research/practice; complication: surgical/technical; diabetes; donors and donation: deceased; islet transplantation; organ procurement; organ procurement and allocation; pancreas/simultaneous pancreas-kidney transplantation; surgical technique