Donor age is the most important predictor of long term graft function in donation after cardiac death simultaneous pancreas-kidney transplantation: A retrospective study

Background: Allografts donated after cardiac death (DCD) are the fastest growing organ source worldwide. Unfortunately, information is lacking on how to judge these organs' viability. Here, we analyzed the effects of donor characteristics, including age and BMI, on outcomes of DCD simultaneous-pancreas-kidney transplantation (SPK). Methods: We evaluated UNOS DCD-SPK transplants from 1988 to 2012. Effects of donor characteristics on graft and recipient survival were evaluated using Cox Regression and the Kaplan-Meier method, and compared to predictions from the pancreas and kidney donor risk indices (PDRI, KDRI). Results: Compared to grafts <= 40(n 38), grafts>40(n 189) had lower 1-year (73.4%+/- 7.2% vs 88.2%+/- 2.4%) and 10-year (50.3% 10% vs 66.3%+/- 6.9%) pancreas survival, and twice the rate of kidney failure (HR2.1, 95%CI 1.15-3.83, p <0.05) and pancreas failure (HR2.07, 95%CI 1.16-3.70, p <0.05). BMI correlated with pancreas failure and recipient mortality. Conclusions: Donor age and BMI are significant predictors of DCD-SPK outcomes. Graft age appears to be as good a predictor of outcome as PDRI and KDRI. (C) 2019 Elsevier Inc. All rights reserved.