Lessons from a 10-year retrospective review of pancreas transplantation in Australia and New Zealand.

Abstract

Aim: To assess the possibility of increasing solid-organ pancreas utilisation for transplantation in Australia and New Zealand (ANZ). Background(s): Solid-organ pancreas transplantation rates in ANZ are lower compared to the UK and USA (1.45 vs 3.05 and 3.09 pmp respectively in 2019). To understand this, we examined local donor characteristics associated with pancreas non-retrieval and non-transplantation. We also applied the Pancreas Donor Risk index (PDRI) to our cohort which has been validated elsewhere to quantify the impact of donor quality on pancreas graft survival. Method(s): Data-linkage between ANZDATA, ANZOD, and the Australia and New Zealand Islet and Pancreas Transplant registry for all solid pancreas transplants from 2007-2016 was obtained. Donor characteristics predictive of pancreas non-retrieval were assessed while donor, recipient and transplant characteristics associated with graft and patient survival were also addressed. PDRI was calculated for all pancreas donors and analysed as an independent covariate. Result(s): 2592 donors authorised to donate pancreas and 385 solid pancreas transplants comprised the study cohort. Medically unstable donor (37%), older age (25%), and logistical factors (14%) were the main reasons for non-retrieval. One- and five-year pancreas graft survival were 90% and 87% respectively. Increased donor age was associated with lower likelihood of pancreas transplantation (OR 0.84, 95% CI 0.81-0.88, p<0.001) and lower pancreas graft survival (HR 1.22, 95% CI 1.05-1.43, p=0.01). PDRI was 0.85-1.15 for most pancreas donors. Given the conservative cohort, PDRI was not associated with local pancreas graft survival. Conclusion(s): A more selective solid pancreas donor cohort exists for ANZ compared to the USA and UK. Selectively extending ANZ solid pancreas donor suitability criteria could significantly increase ANZ pancreas utilisation without a major compromise in transplant outcomes.