Selected mildly obese donors can be used safely in simultaneous pancreas & kidney transplantation

Abstract

Background. Donor obesity, defined as donor body mass index (D-BMI) of 30 kg/m2 or greater, has been associated with increased risk of technical failure and poor pancreas allograft outcomes. Many transplant centers establish a threshold of D-BMI of 30 kg/m2 to decline donor offers for pancreas transplantation. However, no previous studies differentiate the impact of mild (D-BMI, 30-35 kg/m2) versus severe obesity (D-BMI, ≥35 kg/m2) on pancreas allograft outcomes.Methods.We examined Organ Procurement Transplant Network database records for 9916 simultaneous pancreas-kidney transplants (SPKT) performed between 2000 and 2013. We categorized donor body mass index (D-BMI) into 4 groups: 20 to 25 (n = 5724), 25 to 30 (n = 3303), 30 to 35 (n = 751), and 35 to 50 kg/m2 (n= 138). Associations of D-BMI with pancreas and kidney allograft failure were assessed bymultivariate Cox regression adjusted for recipient, donor, and transplant factors.Results.Compared with D-BMI 20 to 25 kg/m2, only D-BMI 35 to 50 kg/m2 was associated with significantly higher pancreas allograft [adjusted hazard ratio [aHR], 1.37; 95% confidence interval (CI], 1.04-1.79] and kidney allograft (aHR, 1.36; CI, 1.02-1.82) failure over the study period (13 years). Donor BMI 30 to 35 kg/m2 did not impact pancreas allograft (aHR, 0.99; CI, 0.86-1.37) or kidney allograft (aHR, 0.98; CI, 0.84-1.15) failure. Similar patterns were noted at 3 months, and 1, 5, and 10 years posttransplant. Conclusions. These data support that pancreata frommildly obese donors (BMI, 30-35 kg/m2) can be safely used for transplantation, with comparable short-term and long-term outcomes as organs from lean donors. Consideration of pancreata from obese donors may decrease the pancreas discard rate.