The impact of time to death in donors after circulatory death on recipient outcome in simultaneous pancreas-kidney transplantation

Abdullah K Malik ¹, Samuel J Tingle ¹, Nicholas Chung ²

¹Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK.
²Northumbria Healthcare NHS Foundation Trust, Cramlington, UK.
³Manchester University NHS Foundation Trust, Manchester, UK.
⁴NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK.
⁵NHS Blood and Transplant, Bristol, UK.
⁶Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
⁷Imperial College Healthcare NHS Trust, London, UK.
⁸Edinburgh Royal Infirmary, Edinburgh, UK.
⁹Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹⁰NHS Blood and Transplant, Bristol, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK.
¹¹Cardiff and Vale University Health Board, Cardiff, UK.
¹²Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK; NHS Blood and Transplant, Bristol, UK.
¹³NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.

⁰Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK.

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons +

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February 15, 2024

View abstract on PubMed

Summary

Donor time to death (TTD) does not impact pancreas graft survival in donors after circulatory death (DCD) simultaneous pancreas-kidney transplants. Minimizing asystolic time, not TTD, is key for better pancreas graft outcomes.

Area Of Science

Transplantation immunology
Organ procurement
Graft survival analysis

Background

Donors after circulatory death (DCD) present challenges due to unpredictable time to death (TTD) and associated warm ischemic time.
Variable warm ischemic periods can negatively impact pancreas graft quality before transplantation.
Limited evidence exists to guide procurement team stand-down times based on DCD TTD.

Purpose Of The Study

To investigate the impact of donor time to death (TTD) on pancreas graft outcomes in simultaneous pancreas-kidney transplantation from DCD donors.
To identify key predictors of pancreas graft loss in this specific transplant population.

Main Methods

Retrospective analysis of UK transplant registry data from 2014 to 2022.
Inclusion of 375 DCD simultaneous kidney-pancreas transplant recipients.
Statistical evaluation using Cox proportional hazards models and restricted cubic spline analysis to assess TTD and asystolic time effects on graft survival.

Main Results

Increasing donor time to death (TTD) was not significantly associated with pancreas graft survival (aHR 0.98, P = .901).
Increasing asystolic time was a significant predictor of pancreas graft loss (aHR 2.51, P = .020).
Restricted cubic spline modeling confirmed no relationship between TTD and graft survival, but a nonlinear relationship between asystolic time and graft survival.

Conclusions

Donor time to death (TTD) does not appear to influence pancreas graft survival in DCD simultaneous pancreas-kidney transplantation.
Minimizing asystolic time is crucial for optimizing pancreas graft survival.
Procurement teams should prioritize reducing asystolic time over focusing on TTD duration.

Keywords:

graft outcome pancreas transplantation: procurement