title: Outcomes From Pancreatic Transplantation in Donation After Cardiac Death: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Pancreas transplantation remains the gold standard for treatment for type I diabetes providing an insulin-independent, normoglycemic state. Increasingly, donation after cardiac death (DCD) donors are used in view of the organ donor shortage. We aimed to systematically review recipient outcomes from DCD donors and where possible compared these with donor after brain death (DBD) donors.
  
  
  METHODS
  We searched the databases MEDLINE via PubMed, EMBASE, and The Cochrane Library from inception to March 2015, for studies reporting the outcome of DCD pancreas transplants. We appraised studies using the Newcastle-Ottawa scale and meta-analyzed using a random effects model.
  
  
  RESULTS
  We identified 18 studies, 4 retrospective and 6 prospective cohort studies and 8 case reports. Our bias assessment revealed that although studies were well conducted, some studies had potential confounding factors and absence of comparator groups. Eight of the 18 studies included a DBD comparison group comprising 23 609 transplant recipients. Importantly, there was no significant difference in allograft survival up to 10 years (hazard ratio, 0.98; 95% confidence interval [95% CI], 0.74-1.31; P = 0.92), or patient survival (hazard ratio, 1.31; 95% CI, 0.62-2.78; P = 0.47) between DCD and DBD pancreas transplants. We estimated that the odds of graft thrombosis was 1.67 times higher in DCD organs (95% CI, 1.04-2.67; P = 0.006). However, subgroup analysis found thrombosis was not higher in recipients whose DCD donors were given antemortem heparin (P = 0.62).
  
  
  CONCLUSIONS
  Using current DCD criteria, pancreas transplantation is a viable alternative to DBD transplantation, and antemortem interventions including heparinization may be beneficial. This potential benefit of DCD pancreas donation warrants further study.
authors.affiliation: 1 Westmead Clinical School, Sydney Medical School, University of Sydney, NSW, Australia. 2 The Centre for Transplant and Renal Research, Westmead Millennium Institute, Westmead, NSW, Australia. 3 Sydney School of Public Health, University of Sydney, NSW, Australia. 4 The Department of Surgery, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Sara
authors.initials: S
authors.lastname: Shahrestani
authors.forename: Angela C
authors.initials: AC
authors.lastname: Webster
authors.forename: Vincent Wai To
authors.initials: VW
authors.lastname: Lam
authors.forename: Lawrence
authors.initials: L
authors.lastname: Yuen
authors.forename: Brendan
authors.initials: B
authors.lastname: Ryan
authors.forename: Henry Claud Capron
authors.initials: HC
authors.lastname: Pleass
authors.forename: Wayne John
authors.initials: WJ
authors.lastname: Hawthorne
mesh_terms: D064591:Allografts; D000925:Anticoagulants / Q000008:administration & dosage; D002423:Cause of Death; D016009:Chi-Square Distribution; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D046148:Donor Selection; D006085:Graft Survival; D006331:Heart Diseases / Q000401:mortality*; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016017:Odds Ratio; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D007166:Immunosuppressive Agents; D006493:Heparin