3Patrick T Anderson, 2,3Vivian McAlister, 1,3Alp Sener, 1,3Patrick P Luke

Divisions of 1Urology and 2Surgery, Department of Surgery, 3Schulich School of Medicine & Dentistry, Western University and London Health Sciences Centre, London, ON, Canada

First Canadian Experience with Donation After Cardiac Death Simultaneous Pancreas-Kidney Transplants

RESULTSINTRODUCTION

• Simultaneous pancreas-kidney (SPK) transplant remains the only definitive treatment modality available for patients with type-1 diabetes complicated by end stage renal disease (ESRD)1

• Despite persistent efforts, the demand for organ donation continues to outpace the availability of organs for transplant2

• This discrepancy has led to the the use of organs from donation after cardiac death (DCD) donors, in addition to the traditionally preferred neurological determination of death (NDD) donor organs3

• DCD organs have traditionally been thought of as inferior in quality due to damage accumulated as a result the prolonged hypotension and warm ischemia experienced during organ procurement4

PURPOSE

The aim of this study was to compare the short and long-term outcomes of patients receiving an SPK transplant with organs from either a DCD donor or a NDD donor

METHODS

• Retrospective case series of all 8 DCD SPK transplants, and 16 contemporaneous NDD SPK transplants, performed at a single centre between 2008 and 2014

• All patients were immunosuppressed by thymoglobulin induction, followed by tacrolimus, mycophenolate mofetil and prednisone triple therapy post-transplant

• Donor and recipient characteristics were collected and compared

• Transfusion requirements and complication rates were reviewed in the post-operative period

• Serum biochemistries, graft, and patient survivals were reviewed up to 6-years post-SPK transplant

Table 1. Donor and recipient characteristics of simultaneous pancreas-kidney transplant patients.

Figure 2. Serum biochemistries following SPK transplant. A) HbA1c, B) amylase, C) lipase, D) eGFR, E) hemoglobin. *denotes statistically significant difference.

Figure 3. Kaplan-Meier survival curves of A) patient, B) kidney allograft, and C) pancreas allograft following SPK transplant. No significant differences in patient or graft survivals were seen up to 6-years post-transplant.

Figure 1. Illustration depicting enteric-draining simultaneous pancreas-kidney transplant with systemic venous drainage.

CONCLUSION

It appears that despite a higher rate of kidney delayed graft function, SPK transplants from DCD donors have similar long-term outcomes to SPK transplants from NDD donors. Our experience supports the use of DCD donor grafts in SPK transplantation.

RESULTS- Summary

• Donor and recipient characteristics were similar between DCD and NDD groups

• Transfusion requirements were similar between DCD and NDD groups

• There was a significantly higher rate of kidney delayed graft function in the DCD group (62.5%) compared to the NDD group (0%). P<0.05

• There was immediate pancreas graft function in all DCD and NDD transplants

• Apart from an initially lower eGFR in the DCD group, serum biochemistries were similar between groups up to 4 years post-SPK

• Patient and graft survivals were similar up to 6 years post-SPK

REFERENCES

1. Sung, R. S., Zhang, M., Schaubel, D. E., Shu, X. & Magee, J. C. A Reassessment of the Survival Advantage of Simultaneous Kidney-Pancreas Versus Kidney-Alone Transplantation. Transplantation (2015)

2. McCullough KP, Keith DS, Meyer KH, Stock PG, Brayman KL, Leichtman AB. Kidney and pancreas transplantation in the United States, 1998–2007: access for patients with diabetes and end-stage renal disease. Am J Transplant 2009; 9: 894–906

3. Suh, N., Ryan, B., Allen, R., O’Connell, P. & Pleass, H. Simultaneous pancreas and kidney transplantation from organ donation after cardiac death. ANZ J Surg 79, 245–6 (2009)

4. Hall, I. E. et al. Associations of deceased donor kidney injury with kidney discard and function after transplantation. Am. J. Transplant. (2015)

For additional information please contact:Dr. Patrick Luke

Multi-Organ Transplant ProgramWestern University CanadaLondon, Ontario, Canadapatrick.luke@lhsc.on.ca

**The authors have no conflicts of interest to disclose.

Table 2. Transfusion requirements and post-operative complication rates. *denotes statistically significant difference