Introduction: Pancreas transplantation is considered the gold standard treatment for patient suffering from type 1 diabetes mellitus. Pancreatic grafts obtained from donation after cardiac death (DCD) and from donation after brain death (DBD) donors can be recovered from local donor service areas (DSAs), or imported from other UNOS regions. DCD donors are increasingly recovered, but given the variance in DCD recovery practices by other recovery teams and the potential for cumulative ischemia time when importing pancreata, the possibility of poor outcomes is heightened. In this study we review our experience with importing and transplanting DCD pancreatic grafts.

Methods: We analyzed 119 primary DCD pancreatic transplants performed at the University of Wisconsin between January 2000 and December 2018. Adult recipients with a minimum of 1 year of follow-up who underwent either pancreas and kidney transplant (SPK), or solitary pancreas transplant (PAN) were included and were divided into three groups based on the source of the graft: local DSA [local], beyond the DSA but within our region [regional] or beyond [national].  The primary outcome was death censored-graft survival (DC-GS) overall, and also stratified by transplant type, geographical source and import status. DC-GS survival was analyzed using Kaplan-Meier analyses and p values <0.05 were considered statistically significant. Up to 30 min of WIT was accepted.

Results: Of 119 recipients of pancreatic DCD grafts, 108 underwent SPK and 11 PAN transplant. Approximately 80% (n=95) of the pancreatic DCD grafts were locally sourced while regional and national imports accounted for 6% (n=7) and 14% (n=17), respectively. Overall, no statistical differences were noted in the DC-GS between locally, regionally and nationally recovered DCD grafts. The 5-year DC-GS rate for all pancreatic DCD grafts was 82% for the local vs 77% for the imported grafts (p=0.95). Of the 108 SPK DCD grafts, 86.1% (n=93) were from local origin and 5.6% (n=6) and 8.3% (n=9) were from regional and national locales, respectively. Overall, 14% (n=15) of all SPK DCD grafts were imported. The 5-year DC-GS rate for the local SPK DCD grafts was 82% vs 78% for regionally and nationally imported grafts combined(p=0.72). However, the 5-year DC-GS of regional DCD SPK grafts was 100% and that of national grafts was only 65% (p=0.23). Only 11 PAN DCD grafts were transplanted in the last 18 years, 1 from regional and 8 from national areas.

Conclusions: With continued shortages of donor organs and the new allocation system in the US, the boundaries of transplantation have been pushed to import more organs and to expand acceptance criteria. DCD donors are increasingly being used for renal and extra-renal transplants, except for pancreata. These data support the use of regionally imported DCD pancreata; however, the use of DCD pancreata with long cold ischemia times may result in excessive risk.