Outcomes for circulatory death and brainstem death pancreas transplantation with or without use of normothermic regional perfusion

Abstract

Simultaneous pancreas and kidney transplantation is the optimal treatment for patients with type 1 diabetes and renal failure, providing survival benefit over deceased kidney transplant alone, and improved quality of life1,2. Waiting list mortality is compounded by a shortage of donor organs and high discard rates3,4. To address this, donation after circulatory death (DCD) donors have been increasingly used and now account for about 30 per cent of all simultaneous pancreas and kidney transplantations in the UK. Marked variation in the utilization of DCD pancreases exists3,4, which may reflect a perception that DCD grafts are 'high risk' compared to organs procured from brainstem dead donors due to additional warm ischaemia. Other factors include differences in withdrawal of life support and variations in the legality of antemortem interventions5. The authors' early experience was similar to that of others6,7, in that there was no difference in short-term survival between those receiving grafts from donation after brainstem death (DBD) or conventional DCD (sDCD) donors. Normothermic regional perfusion is a promising technique to reduce the additional ischaemic insult associated with DCD by placing the donor on a modified extracorporeal membrane oxygenator circuit in order to restore circulation of oxygenated blood to the organs following cardiorespiratory arrest. In liver transplantation, normothermic regional perfusion leads to superior outcomes compared with sDCD8-10. It is unclear if the benefits of normothermic regional perfusion extend to DCD pancreas transplantation. The aim of this study was to evaluate a decade of a DCD pancreas transplant programme and a cohort of DCD pancreas transplants performed with or without normothermic regional perfusion. Methods All consecutive simultaneous pancreas and kidney transplantations performed at Addenbrooke's Hospital, Cambridge, UK from 1 August 2008 to 31 July 2018 were included in this study. Full methodology is provided in detail in the supplementary material. Results A total of 211 patients (139 DBD and 72 DCD, of which 59 were sDCD and 13 normothermic regional perfusion) were included. The donor, recipient and transplant characteristics are summarized in Table S1.