M.L. Di Napoli1, R.A. Choudhury1, M. Baimas-George1, Y. Bababekov1, S. Bakhtiyar1, A.D. Rouhi2, T.L. Nydam1, P.T. Kennealey1 1University of Colorado Hospital, Division Of Transplant Surgery, Aurora, CO, USA 2Hospital Of The University Of Pennsylvania, Department Of Surgery, Philadelphia, PA, USA
Introduction: Pancreas transplantation from donation after cardiac death (DCD) donors accounts for less than 5% of all pancreas transplants annually. This is largely due to fear of increased complications and graft failure. While many studies retort these reservations, there is still significant underutilization of viable grafts. Normothermic regional perfusion (NRP) has increasingly been used in the DCD setting to test pancreas organ viability and to mitigate the effects of warm ischemia. As a result, more transplant centers are accepting DCD pancreas allografts when NRP procurement technique is utilized.
Methods: A decision analytic Markov state transition model was created to simulate the outcome of waitlisted simultaneous kidney pancreas (SPK) patients. The base case patient was a 35-year-old male on hemodialysis with end-stage renal disease secondary to type 1 diabetes mellitus. Patients were assigned to 4 different pathways based on acceptance criteria: 1) standard; 2) mildly aggressive; 3) moderately aggressive; and 4) aggressive. The standard pathway is based on current published data on DCD pancreas acceptance. Mild, moderate, and aggressive simulations were created to estimate the impact of increasing the viable pancreas allograft pool with NRP, with the highest estimate, “aggressive”, assuming a 50% increase.
Results: The increased organ availability with NRP resulted in an expected increase in patients who received an SPK transplant. At 5 years, over 63% of patients in the “aggressive” model had been transplanted compared with just 46% in the standard model. Additionally, with increasingly aggressive acceptance practices, there was improved patient survival (Figure 1); in the “aggressive” model, 70% of patients were living at 5 years compared to 60% in the standard model.
Conclusion: NRP provides the opportunity to monitor pancreas function in situ, increasing the willingness of providers to accept grafts from DCD donors that would have otherwise been declined. Widespread adoption has not yet occurred, but as NRP use continues to increase across the United States, this will have significant implications for the SPK waitlist with the opportunity to increase the number of patients receiving a lifesaving transplant.