Donation After Circulatory Death in Simultaneous Pancreas-Kidney Transplant Lags Despite Comparable Outcomes and...

Pancreas transplant provides definitive treatment for uncontrolled insulin-dependent diabetes, yet use of donation after circulatory death pancreases remains limited due to concerns about higher complication rates and reduced graft survival versus donation after brain death. We (1) assessed circulatory death simultaneous pancreas-kidney transplants from 2015-2019 and 2020-2024, (2) reviewed donor/recipient characteristics, and (3) compared outcomes of circulatory versus brain death donation in simultaneous pancreas-kidney transplants.

In a retrospective cohort analysis of all adult simultaneous pancreas-kidney transplants for 2015-2024 (n = 6934; United Network of Organ Sharing), we divided recipients as donation after circulatory death (n = 219) and brain death (n = 6715). We evaluated donor, recipient, and simultaneous pancreas-kidney transplant characteristics associated with graft survival.

No significant difference was shown in the proportion of circulatory death transplants for 2015-2019 versus 2020-2024 (95% CI, -0.0125 to 0.004; P = .3). Circulatory death transplant recipients had a higher proportion of type 2 diabetes and were more likely to be treated at high-volume centers. Donation after circu-latory death transplants were more often from male, non-Hispanic White donors, with higher Kidney Donor Profile Indexes. Kidney delayed graft function was higher among circulatory death donors (26.50% vs 8.40%; P < .001). No significant difference in 5-year pancreas graft survival was observed between recipients of circulatory death and brain death transplants (hazard ratio = 0.88; P = .456). Higher recipient body mass index (hazard ratio = 1.04; P < .001), kidney delayed graft function (hazard ratio = 1.72; P < .001), and cytomegalovirus donor-positive/recipient-negative se-rostatus (hazard ratio = 1.29; P = .004) were independently associated with poorer graft survival.

Donation after circulatory death simultaneous pancreas-kidney outcomes parallel results from brain death transplants, yet use remains low. Optimized donor management could expand the pancreas donor pool and enhance transplant access.