title: Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death.
abstract: BACKGROUND
  To overcome the gap of organ shortage grafts from donation after circulatory death (DCD) can be used. This review evaluates the outcomes after DCD pancreas donation compared to donation after brain death (DBD).
  
  
  METHODS
  A literature search was performed using Medline, Embase, and PubMed databases. All comparative cohort studies reporting the outcome after DCD and DBD pancreas transplantation were included. All data were assessed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. To evaluate the event rates, pooled odds ratios (ORs) as well as the 95% confidence intervals (CI) were calculated. Since the number of studies is small we used the random-effects model only to overcome heterogeneity.
  
  
  RESULTS
  There is no difference in 1-year pancreas graft survival (OR 1.092, CI 95% 0.649-1.837, P = 0.741) or patient survival (OR 0.699, CI 95% 0.246-1.985, P = 0.502). Simultaneous pancreas-kidney (SPK) transplantation showed significantly higher graft survival rates compared to pancreas transplantation alone (87.2% vs. 76.6%, P < 0.001 in DBD and 86.5% vs. 74.9%, P < 0.001 in DCD). DCD SPK grafts show a higher delayed kidney graft function rate compared to DBD SPK-grafts (OR 0.209, CI 95% 0.104-0.421, P < 0.001). There is significantly less pancreas graft thrombosis after DBD-donation (OR 0.567, CI 95% 0.340-0.946, P = 0.030). We found no difference in the HbA1c level at 1-year follow-up with a median of 5.4% in both groups and a mean of 5.63% (DCD) vs 5.43% (DBD).
  
  
  CONCLUSIONS
  DCD pancreas transplantation has comparable patient and 1-year graft survival rates and should be considered a safe alternative for DBD pancreas transplantation.
authors.affiliation: Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: esvanloo@home.nl.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: van Loo
authors.affiliation: Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: c.krikke@umcg.nl.
authors.forename: Christina
authors.initials: C
authors.lastname: Krikke
authors.affiliation: Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: s.h.hofker@umcg.nl.
authors.forename: Hendrik S
authors.initials: HS
authors.lastname: Hofker
authors.affiliation: Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: s.p.berger@umcg.nl.
authors.forename: Stefan P
authors.initials: SP
authors.lastname: Berger
authors.affiliation: Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: h.g.d.leuvenink@umcg.nl.
authors.forename: Henri G D
authors.initials: HG
authors.lastname: Leuvenink
authors.affiliation: Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: pol.chirurgie@gmail.com.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Pol
mesh_terms: D001926:Brain Death; D006085:Graft Survival; D006801:Humans; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D016035:Pancreas Transplantation / Q000401:mortality; D012769:Shock; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods*
keywords: Brain death; Circulatory death; Outcome; Pancreas; Survival; Transplantation