Outcome-Orientated Organ Allocation-A Composite Risk Model for Pancreas Graft Evaluation and Acceptance.

Area of Science:

• Transplantation immunology
• Organ transplantation
• Diabetology

Background:

• Pancreas transplantation (PTX) is the primary treatment for endocrine pancreatic insufficiency, particularly in type 1 diabetes.
• Optimal risk stratification of donor factors is crucial to mitigate early graft loss (EGL) and perioperative complications.

Purpose of the Study:

• To retrospectively identify and analyze donor risk factors impacting EGL and graft survival in PTX.
• To develop a composite risk model for evaluating pancreas grafts.

Main Methods:

• Retrospective analysis of 97 PTX cases (2010-2021) at a single center.
• Statistical analysis using Kaplan-Meier method and log-rank test to assess donor risk factors.
• Development of a composite risk model incorporating significant factors.

Main Results:

• The overall EGL rate was 6.5%.
• Multivariate analysis identified donor age > 45, BMI > 25 kg/m², lipase > 60 U/L, mechanical cardiopulmonary resuscitation (mCPR), and cold ischemia time (CIT) > 600 min as impactful factors.
• A composite model showed that three or more risk factors significantly increased EGL (p=0.003) and reduced graft survival (p=0.029).

Conclusions:

• Grafts with three or more identified donor risk factors require careful consideration before acceptance.
• Implementing this risk stratification can significantly reduce EGL and improve patient outcomes after PTX.