Andrea Proneth1, Andreas A Schnitzbauer1,2, Peter Schenker3, Andreas Wunsch3, Falk Rauchfuss4, Helmut Arbogast5, Steffen Manekeller6, Silvio Nadalin7, Michael Heise8, Michael A Ströhlein9, Bernhard Banas10, Peter Schemmer11, Thomas Becker12, Wolf O Bechstein2, Andreas Pascher13, Richard Viebahn3, Edward K Geissler1, Hans J Schlitt1, Stefan A Farkas1. 1. Department of Surgery, University Hospital Regensburg, Regensburg, Germany. 2. Department of General and Visceral Surgery, Goethe-University Hospital and Clinics, Frankfurt am Main, Germany. 3. Department of Surgery, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany. 4. Department of General, Visceral and Vascular Surgery, University Hospital Jena, Jena, Germany. 5. Department of Surgery, University Hospital Grosshadern, Ludwig Maximilian's University, Munich, Germany. 6. Department of Surgery, University Hospital Bonn, Bonn, Germany. 7. Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany. 8. Department of General, Visceral and Transplantation Surgery, Johannes Gutenberg University Mainz, Mainz, Germany. 9. Department of Abdominal, Vascular, and Transplant Surgery, Cologne-Merheim Medical Center, Witten/Herdecke University, Köln, Germany. 10. Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany. 11. Department of General, Visceral and Transplant Surgery, University Hospital of Heidelberg, Heidelberg, Germany. 12. Department of General and Thoracic Surgery, University Hospital Schleswig-Holstein, Kiel, Germany. 13. Department of General, Visceral and Transplantation Surgery, Charité-University Medicine Berlin, Berlin, Germany.
Abstract
BACKGROUND: Pancreas transplantation is the only curative treatment option for patients with juvenile diabetes. Organ shortage and restrictive allocation criteria are the main reasons for increasing waitlists, leading to severe morbidity and mortality. We designed a study to increase the donor pool with extended donor criteria (EDC) organs (donor age, 50-60 years; body mass index, 30-34 kg/m). METHODS: Utilization of EDC organs required the implementation of a new allocation system within Eurotransplant. The study was a prospective, multicenter, 2-armed trial. The primary endpoint was pancreas function after 3 months. Rejection episodes, kidney function, and waitlist time were secondary endpoints. Patients receiving an EDC organ were study group patients; recipients of standard organs were control group patients. Follow-up was 1 year. RESULTS: Seventy-nine patients were included in 12 German centers, 18 received EDC organs and 61 received standard organs. Recipient demographics were similar. Mean EDC donor age was 51.4 ± 5 years versus 31.7 ± 12 in the control group. Insulin-free graft survival was 83.3% for EDC and 67.2% for standard organs (P = 0.245) after 3 months. One-year pancreas survival was 83.3% and 83.5% in the EDC versus standard group. One-year kidney allograft survival was approximately 94% in both groups. Rejection episodes and morbidity were similar. CONCLUSIONS: The Extended Pancreas Donor Program (EXPAND) shows in a prospective trial that selected EDC organs of donors older than 50 years can be used with outcomes similar to standard-criteria organs, therefore showing potential to reduce organ shortage and waiting times. This study substantiates the full implementation of EDC organs in a pancreas allocation system.
BACKGROUND: Pancreas transplantation is the only curative treatment option for patients with juvenile diabetes. Organ shortage and restrictive allocation criteria are the main reasons for increasing waitlists, leading to severe morbidity and mortality. We designed a study to increase the donor pool with extended donor criteria (EDC) organs (donor age, 50-60 years; body mass index, 30-34 kg/m). METHODS: Utilization of EDC organs required the implementation of a new allocation system within Eurotransplant. The study was a prospective, multicenter, 2-armed trial. The primary endpoint was pancreas function after 3 months. Rejection episodes, kidney function, and waitlist time were secondary endpoints. Patients receiving an EDC organ were study group patients; recipients of standard organs were control group patients. Follow-up was 1 year. RESULTS: Seventy-nine patients were included in 12 German centers, 18 received EDC organs and 61 received standard organs. Recipient demographics were similar. Mean EDC donor age was 51.4 ± 5 years versus 31.7 ± 12 in the control group. Insulin-free graft survival was 83.3% for EDC and 67.2% for standard organs (P = 0.245) after 3 months. One-year pancreas survival was 83.3% and 83.5% in the EDC versus standard group. One-year kidney allograft survival was approximately 94% in both groups. Rejection episodes and morbidity were similar. CONCLUSIONS: The Extended Pancreas Donor Program (EXPAND) shows in a prospective trial that selected EDC organs of donors older than 50 years can be used with outcomes similar to standard-criteria organs, therefore showing potential to reduce organ shortage and waiting times. This study substantiates the full implementation of EDC organs in a pancreas allocation system.
Authors: Franka Messner; Marjolein Leemkuil; Yifan Yu; Allan B Massie; Felix J Krendl; Stan Benjamens; Claudia Bösmüller; Annemarie Weissenbacher; Stefan Schneeberger; Robert A Pol; Christian Margreiter Journal: Transpl Int Date: 2021-03-01 Impact factor: 3.782
Authors: Yakup Kulu; Elias Khajeh; Omid Ghamarnejad; Mohammadsadegh Nikdad; Mohammadsadegh Sabagh; Sadeq Ali-Hasan-Al-Saegh; Silvio Nadalin; Markus Quante; Przemyslaw Pisarski; Bernd Jänigen; Christoph Reißfelder; Markus Mieth; Christian Morath; Benjamin Goeppert; Peter Schirmacher; Oliver Strobel; Thilo Hackert; Martin Zeier; Rainer Springel; Christina Schleicher; Markus W Büchler; Arianeb Mehrabi Journal: Medicine (Baltimore) Date: 2020-03 Impact factor: 1.817