title: Long-term Outcomes for Living Pancreas Donors in the Modern Era.
abstract: Living donor segmental pancreas transplants (LDSPTx) have been performed selectively to offer a preemptive transplant option for simultaneous pancreas-kidney recipients and to perform a single operation decreasing the cost of pancreas after kidney transplant. For solitary pancreas transplants, this option historically provided a better immunologic match. Although short-term donor outcomes have been documented, there are no long-term studies.
  
  
  
  We studied postdonation outcomes in 46 segmental pancreas living donors. Surgical complications, risk factors (RF) for development of diabetes mellitus (DM) and quality of life were studied. A risk stratification model (RSM) for DM was created using predonation and postdonation RFs. Recipient outcomes were analyzed.
  
  
  
  Between January 1, 1994 and May 1, 2013, 46 LDSPTx were performed. Intraoperatively, 5 (11%) donors received transfusion. Overall, 9 (20%) donors underwent splenectomy. Postoperative complications included: 6 (13%) peripancreatic fluid collections and 2 (4%) pancreatitis episodes. Postdonation, DM requiring oral hypoglycemics was diagnosed in 7 (15%) donors and insulin-dependent DM in 5 (11%) donors. RSM with three predonation RFs (oral glucose tolerance test, basal insulin, fasting plasma glucose) and 1 postdonation RF, greater than 15% increase in body mass index from preoperative (Δ body mass index >15), predicted 12 (100%) donors that developed postdonation DM. Quality of life was not significantly affected by donation. Mean graft survival was 9.5 (±4.4) years from donors without and 9.6 (±5.4) years from donors with postdonation DM.
  
  
  
  LDSPTx can be performed with good recipient outcomes. The donation is associated with donor morbidity including impaired glucose control. Donor morbidity can be minimized by using RSM and predonation counseling on life style modifications postdonation.
authors.affiliation: 1 Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN. 2 Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, MN. 3 Division of Nephrology, Department of Medicine, University of Minnesota, Minneapolis, MN. 4 Division of Transplantation, Department of Surgery, Upstate Medical University SUNY, Syracuse, NY. 5 Division of Transplantation, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: Varvara A
authors.initials: VA
authors.lastname: Kirchner
authors.forename: Erik B
authors.initials: EB
authors.lastname: Finger
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: Rainer W G
authors.initials: RW
authors.lastname: Gruessner
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Hering
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: Aleksandra K
authors.initials: AK
authors.lastname: Kukla
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Matas
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Pruett
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.forename: Raja
authors.initials: R
authors.lastname: Kandaswamy
mesh_terms: D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D048909:Diabetes Complications / Q000601:surgery; D005260:Female; D005951:Glucose Tolerance Test; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000191:economics / Q000379:methods; D008019:Life Style; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000601:surgery*; D016035:Pancreas Transplantation / Q000191:economics / Q000379:methods*; D011788:Quality of Life; D012307:Risk Factors; D013156:Splenectomy; D016896:Treatment Outcome; D055815:Young Adult