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Living Donor Pancreas Transplants: Donor Selection and Risk Minimization

  • Pancreas Transplantation (D Axelrod, Section Editor)
  • Published:
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Abstract

Purpose of Review

In this study, our goal was to analyze nearly 4 decades of experience since the first living donor pancreas transplant in 1979, focusing on what constitutes optimal donor selection and ideal post donation follow-up.

When combined with a living donor kidney transplant, a living donor pancreas transplant offers patients with concurrent renal failure and diabetes the option of a single procedure: a living donor simultaneous pancreas-kidney (SPK) transplant. Living donor SPK transplants not only can reduce the waiting time in areas where it is long but also, for highly sensitized patients, can electively identify a donor with a negative crossmatch.

Recent Findings

Although living donor pancreas (and simultaneous pancreas-kidney) transplants were initially performed open, they evolved to laparoscopic procedures in 1999. The technical failure rates have improved over the years. Guidelines for reducing donor morbidity have incorporated the use of biochemical markers and stricter donor selection criteria. Predonation assessment of donors’ beta-cell mass may help identify those at risk of developing diabetes.

Summary

Living donor pancreas transplants can be performed safely and with good outcomes; they remain an important option for highly sensitized transplant candidates and can reduce waiting time in areas where it is long. For donors, stringent selection criteria, robust predonation counseling, and meticulous postdonation follow-up are essential.

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Abbreviations

ATG:

Antithymocyte globulin

BMI:

Body mass index

CT:

Computed tomography

LD:

Living donor

DM:

Diabetes mellitus

DD:

Deceased donor

SPK:

Simultaneous pancreas-kidney

PAK:

Pancreas after kidney

PTA:

Pancreas transplant alone

AR:

Acute rejection

PRA:

Panel-reactive antibody

SRTR:

Scientific Registry of Transplant Recipients

QOL:

Quality of life

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. Kandaswamy R, Stock PG, Gustafson SK, Skeans MA, Curry MA, Prentice MA, Israni AK, Snyder JJ, Kasiske BL. OPTN/SRTR 2015 annual data report: pancreas. Am J Transplant. 2017;17(Suppl 1):117–73.

    Article  PubMed  Google Scholar 

  2. •• Sutherland DE, Radosevich D, Gruessner R, et al. Pushing the envelope: living donor pancreas transplantation. Curr Opin Organ Transplant. 2012;17:106–15. This article gives a detailed description and discussion on the outcomes of living donor pancreas transplantation since its inception to the modern age.

    Article  PubMed  Google Scholar 

  3. •• Gruessner AC, Gruessner RW. Pancreas transplant outcomes for United States and non United States cases as reported to the United Network for Organ Sharing and the International Pancreas Transplant Registry as of December 2011. Clin Transpl. 2012:23–40. Provides the database for the worldwide activities in the field of pancreas transplant including living donor.

  4. Sutherland DE, Goetz FC, Najarian JS. Living-related donor segmental pancreatectomy for transplantation. Transplant Proc. 1980;12(4 Suppl 2):19–25.

    CAS  PubMed  Google Scholar 

  5. Gruessner RWG, Sutherland DER. Simultaneous kidney and segmental pancreas transplants from living related donors—the first two successful cases. Transplantation. 1996;61:1265–8.

    Article  CAS  PubMed  Google Scholar 

  6. Tan M, Kandaswamy R, Sutherland DE, Gruessner RW. Laparoscopic donor distal pancreatectomy for living donor pancreas and pancreas-kidney transplantation. Am J Transplant. 2005;5:1966–70.

    Article  PubMed  Google Scholar 

  7. Oberholzer J, Tzvetanov I, Mele A, Benedetti E. Laparoscopic and robotic donor pancreatectomy for living donor pancreas and pancreas-kidney transplantation. J Hepatobiliary Pancreat Sci. 2010;17:97–100.

    Article  PubMed  Google Scholar 

  8. Levi Sandri GB, de Werra E, et al. The use of robotic surgery in abdominal organ transplantation: a literature review. Clin Transpl. 2016;00:1–6. Accepted October. doi:10.1111/ctr.12856.

    Google Scholar 

  9. Humar A, Gruessner RW, Sutherland DE. Living related donor pancreas and pancreas-kidney transplantation. Br Med Bull. 1997;53:879–91.

    Article  CAS  PubMed  Google Scholar 

  10. Han DJ, Sutherland DER. Pancreas transplantation. Gut Liver. 2010;4:450–65.

    Article  PubMed  PubMed Central  Google Scholar 

  11. •• Kirchner VA, Finger EB, Bellin MD, et al. Long-term outcomes for living pancreas donors in the modern era. Transplantation. 2016;100:1322-1328. Shares experience of perioperative and long term metabolic outcomes of living pancreas donors and suggests ways to improve donor risk.

  12. Reynoso JF, Gruessner CE, Sutherland DER, et al. Short and long-term outcome for living pancreas donors. J of Hepatobiliary Pancreat Sci. 2010;17:92–6.

    Article  Google Scholar 

  13. Choi JY, Jung JH, Kwon H, et al. Pancreas transplantation from living donors: a single-center experience of 20 cases. Am J Transplant. 2016;16:2413–20.

    Article  CAS  PubMed  Google Scholar 

  14. Kenmochi T, Asano T, Maruyama M, et al. Living donor pancreas transplantation in Japan. J Hepatobiliary Pancreat Sci. 2010;17:101–7.

    Article  PubMed  Google Scholar 

  15. Park KT, Jun H, Kim MG, et al. Simultaneous pancreas-kidney transplantation from living donors using hand-assisted laparoscopic donor surgery: single-center experience. Transplant Proc. 2015;47:1096–8.

    Article  PubMed  Google Scholar 

  16. Lam NN, Schintzler MA, Segev DL et al. Diabetes mellitus in living pancreas donors: use of integrated national registry and pharmacy claims data to characterize donation related health outcomes. Transplantation. 2016.

  17. •• Otsuki K, Akutsu N, Maruyama M, et al. Three-dimensional computed tomographic volumetric changes in pancreas before and after living donor surgery for pancreas transplantation: effect of volume on glucose metabolism. Transplant Proc. 2014;46(3):963–6. Proposes volumetric assessment as a tool to predict new onset diabetes mellitus following living donation of pancreas.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The authors would like to Ms. Mary E. Knatterud, PhD, for her editorial help in preparation of this article.

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Authors and Affiliations

  1. Division of Transplantation, Department of Surgery, University of Minnesota, Mayo Mail Code 195, 420 Delaware Street SE, Minneapolis, MN, 55455, USA

    Bodhisatwa Sengupta, Oscar K. Serrano, David E. R. Sutherland & Raja Kandaswamy

Authors
  1. Bodhisatwa Sengupta
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  2. Oscar K. Serrano
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  3. David E. R. Sutherland
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  4. Raja Kandaswamy
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Corresponding author

Correspondence to Bodhisatwa Sengupta.

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Conflict of Interest

Bodhisatwa Sengupta, Oscar Serrano, David Sutherland, and Raja Kandaswamy declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Pancreas Transplantation

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Sengupta, B., Serrano, O.K., Sutherland, D.E.R. et al. Living Donor Pancreas Transplants: Donor Selection and Risk Minimization. Curr Transpl Rep 4, 135–140 (2017). https://doi.org/10.1007/s40472-017-0152-y

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