The Use of Pediatric Donors in Pancreas Transplantation

The use of pediatric donors in simultaneous pancreas-kidney transplantation (SPKT) and solitary pancreas transplantation is not universally accepted METHODS: Single center retrospective review of 310 consecutive SPKTs and 50 solitary pancreas transplants performed from 11/1/01 to 1/1/25. All patients received depleting antibody induction with tacrolimus/mycophenolate/prednisone maintenance therapy. Pediatric donors were defined as age <18 years.

In the SPKT group, 72 patients (23.2%) received organs from donors <18 years (mean 13.9 years), 215 from donors 18-40 years (mean 26.4 years), and 23 from donors >40 years of age (mean 47.4 years). Rates of early pancreas thrombosis were 5.6%, 6.5%, and 4.3% (p = 0.51), according to increasing donor age category. One-year death-censored pancreas and kidney graft survival rates (GSRs) were 93.0%, 92.0%, and 90.5%; and 98.6%, 99.1%, and 95.5%, respectively (both p = NS). Four-year death-censored pancreas GSRs were 87.9%, 78.7%, and 90.5%, respectively (p = 0.08). There were 11 pediatric donors ≤40 kg body weight (smallest 28 kg). One-year patient, pancreas, and kidney GSRs were 100% and 4-year patient and pancreas GSRs were 100% (kidney GSR 90%). There were no technical pancreas or kidney graft losses in the ≤40 kg donor group, and pancreas graft survival beyond 18 years has occurred. In 11 patients receiving solitary pancreas transplants from pediatric donors, there were no cases of early thrombosis.

Despite concerns related to small caliber vessels and donor/recipient size mismatch, pediatric donors are associated with excellent mid-term outcomes in SPKT recipients and may not represent a contraindication to pancreas utilization in solitary pancreas transplantation.