Transplantation direct · 2026
Simultaneous Pancreas and Kidney Transplant Recipients From Pediatric Donors Have Comparable Outcomes to Those From Adult Donors, Regardless of the Type of Donation.
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Parajuli Sandesh, Ylagan Camille, Patel Dave, Schindler Paul E, Ram Sundeep, Thiessen Carrie, Aufhauser David, Tamburrini Riccardo, Mandelbrot Didier, Kaufman Dixon, Odorico Jon
Аннотация
BACKGROUND: Increased use of pediatric donors or donation after circulatory death (DCD) donors could enlarge the pancreas transplant donor pool. Pediatric donors and DCD donors are underutilized but are associated with similar outcomes following simultaneous pancreas and kidney (SPK) transplantation, compared with adult donation after brain death (DBD) donors. However, SPK outcomes from donors in whom both variables are present are unknown.
METHODS: Recipients were categorized into 4 groups based on the age of the donor and types of donations: DBD/≥18 y, DBD/<18 y, DCD/≥18 y, and DCD/<18 y. Kidney and pancreas graft functions were compared at various time frames. Risk of graft failure was the primary outcome.
RESULTS: Of 234 SPK recipients, 127 (54%) were DBD/≥18 y, 43 (18%) DBD/<18 y, 49 (21%) DCD/≥18 y, and 15 (6%) DCD/<18 y. There were no significant differences among the groups in overall or death-censored graft failure of either organ. Multivariable analysis (reference to DBD/≥18) showed no significant risk for pancreas uncensored graft failure for DBD/<18 y (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.23-1.44; P = 0.24), DCD/≥18 y (HR, 0.62; 95% CI, 0.26-1.48; P = 0.29), or DCD/<18 y (HR, 0.92; 95% CI, 0.31-2.79; P = 0.89). Pancreas graft function, as assessed by glycated hemoglobin, was comparable up to 5 y posttransplant or at the last follow-up. Kidney function, incidence of pancreas or kidney biopsy-proven rejection, posttransplant diabetes, length of stay, or readmission rates were not significantly different across the groups.
CONCLUSIONS: SPK transplants using DCD organs from pediatric donors can be used without compromising outcomes.
METHODS: Recipients were categorized into 4 groups based on the age of the donor and types of donations: DBD/≥18 y, DBD/<18 y, DCD/≥18 y, and DCD/<18 y. Kidney and pancreas graft functions were compared at various time frames. Risk of graft failure was the primary outcome.
RESULTS: Of 234 SPK recipients, 127 (54%) were DBD/≥18 y, 43 (18%) DBD/<18 y, 49 (21%) DCD/≥18 y, and 15 (6%) DCD/<18 y. There were no significant differences among the groups in overall or death-censored graft failure of either organ. Multivariable analysis (reference to DBD/≥18) showed no significant risk for pancreas uncensored graft failure for DBD/<18 y (hazard ratio [HR], 0.58; 95% confidence interval [CI], 0.23-1.44; P = 0.24), DCD/≥18 y (HR, 0.62; 95% CI, 0.26-1.48; P = 0.29), or DCD/<18 y (HR, 0.92; 95% CI, 0.31-2.79; P = 0.89). Pancreas graft function, as assessed by glycated hemoglobin, was comparable up to 5 y posttransplant or at the last follow-up. Kidney function, incidence of pancreas or kidney biopsy-proven rejection, posttransplant diabetes, length of stay, or readmission rates were not significantly different across the groups.
CONCLUSIONS: SPK transplants using DCD organs from pediatric donors can be used without compromising outcomes.