PITTSBURGH, Jan. 27 -- Transplanting pancreases from "marginal" donors -- those who are clinically unstable or over the age of 45 -- can significantly expand the pool of donated organs, which are currently in scarce supply, and double the number of pancreases transplanted into diabetic patients, a team from the University of Pittsburgh Medical Center (UPMC) reports today in the journal Transplantation. In fact, those organs did just as well, if not better, than organs from ideal donors, the results of the study show.
The chronic shortage of organs has forced UPMC surgeons into the practice of accepting organs from marginal donors. But the shortage is compounded by problems with the national distribution system, namely that organ procurement organizations (OPOs) do not always obtain family consent for pancreas donation, and that donated pancreases are often discarded or are not shared outside the OPO's local area or region.
"Utilization of pancreas grafts varies from 0 percent to more than 70 percent among different procurement regions," wrote the authors.
"With demand for organs far exceeding the supply of optimal donors, we have instituted an aggressive policy that does not exclude organs based on age or hemodynamic status," says Robert J. Corry, M.D., professor of surgery and director of pancreas transplantation at the University of Pittsburgh's Thomas E. Starzl Transplantation Institute, who notes that the region surrounding Pittsburgh has among the highest numbers of older and senior adults in the United States.
In their study, UPMC surgeons followed 137 patients transplanted between July 1994 and March 1998 with organs procured by the center's own surgeons. With a mean follow-up of nearly two years, the overall graft survival rate was 83 percent. But in a subset of patients who received organs from donors over the age of 45, the survival was 86 percent. Thirteen of these patients' donors were between 50 and 62 years of age, and 92 percent maintained functioning grafts. Another subset consisting of 51 patients who received organs from clinically unstable donors had a graft survival of 86 percent.
"There was no significant difference found in graft survival between recipients of pancreatic grafts from marginal and nonmarginal donors," say the authors.
Furthermore, patients with marginal grafts did not have higher rates of complications, and although by certain clinical measures grafts were slower to function in patients whose organs were from less stable patients, the long-term graft survival and function were not adversely affected.
The surgeons reported that the best assessment of the suitability of an organ is visual inspection for calcification, fat and evidence of fibrosis.
All of the 137 patients in the study were diabetic with major complications of their disease. The majority, 117, received simultaneous kidney and pancreas transplants. Eight patients underwent solitary pancreas transplantation, and 12 were kidney recipients who had a second operation to transplant the pancreas.
According to the study, the patients who did the best with marginal donors were those receiving simultaneous kidney-pancreas transplants and those receiving solitary pancreases.
Pancreas transplantation reverses or arrests many of the major complications of diabetes. It significantly improves quality of life, and some researchers argue it to be a life-saving procedure.
Diabetes affects 16 million Americans. According to the United Network for Organ Sharing (UNOS), more than 2,200 patients are awaiting kidney-pancreas or pancreas transplants in the United States. (More than 40,000 are awaiting kidneys.) In 1997, there were 5,475 cadaveric donors, but only 1,316 pancreases were removed from these donors. According to UNOS, which oversees the nation's procurement and transplant network under federal contract, nearly 11 percent of recovered pancreases are discarded at the local OPO level, the highest rate for all the organ types.
In addition to Dr. Corry, other authors include Sandip Kapur, M.D.; C. Andrew Bonham, M.D.; S. Forrest Dodson, M.D.; and Igor Dvorchik, Ph.D. Their results were presented at the 24th Annual Meeting of the American Society of Transplant Surgeons in Chicago last May. Today's journal also contained another paper from the University of Pittsburgh that examined the favorable results obtained using the anti-rejection drug tacrolimus, or Prograf, for patients who receive kidney and kidney-pancreas transplants.
CONTACT:
Craig Dunhoff
Fax: 412-624-3184
E-mail: dunhoffcc@msx.upmc.edu
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Journal
Transplantation