221-OR: Pancreas Transplantation from Pediatric Donors: An Opportunity to Increase Donor Pool

Background: Pancreas transplants (PTx) from pediatric donors (PDs, age <18 years) might expose to greater technical difficulties and provide less insulin independence in the long-term due to smaller beta cells mass. Most available data on pancreas transplants from PDs relate to simultaneous pancreas-kidney transplants, whereas little is known on pancreas transplant alone (PTA) from PDs.

Methods: We retrospectively analyzed perioperative surgical complications and graft survival in T1D recipients of PTA or pancreas after kidney (PAK) transplant from PDs or adult donors (ADs) between Jan 2010 and May 2018. Data were collected through electronic medical record review.

Results: A total of 43 PTx recipients (35 PTA) had data available for analyses. Age at PTx was 40.0±8.3 years, T1D duration 25±10 years, 46.5% female, BMI 23±3 k/m2. Nearly half (49%) pancreas grafts were from PDs. Median donor age was 18 [IQR: 16] years (min. 2, max 45 years). Donor characteristics (age, BMI, body surface area [BSA]) significantly differed between groups (all p<0.05), but recipient characteristics (age at PTx, T1D duration, BMI) were similar. Median length of stay was similar in the AD and PD groups (17.5 [8.5] vs. 14 [7.0] days, p=NS). Rates of any perioperative surgical complications (55% vs. 33%), re-laparotomy (41% vs. 19%) and explanation (36% vs. 10%) were numerically lower and early graft thrombosis was significantly lower (55% vs. 10%, p<0.01) in the PD group. Median graft survival was numerically greater in the AD vs. the PD group (8.5 vs. 5.7 years, p=0.34). However, rejection rate was significantly higher in the PD group (4.5% vs. 52%, p<0.01). We found no correlation between donor characteristics (age, BMI, BSA and donor/recipient BSA ratio) and graft survival.

Conclusions: PTx from PDs tended to be associated with less surgical complications vs. PTx from ADs. Graft survival was similar. Expanding selection criteria to include PDs would increase the availability of pancreas grafts and possibly improve clinical outcomes.