Kapur S, Bonham C A, Dodson S F, Dvorchik I, Corry R J
Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pennsylvania, USA.
Transplantation. 1999 Jan 27;67(2):284-90. doi: 10.1097/00007890-199901270-00017.
Our organ procurement organization has been forced to liberalize the donor criteria in order to expand the donor pool for pancreas transplantation. In this report, we describe our experience using whole organ pancreatic grafts from "marginal" donors, which include grafts obtained from donors over 45 years of age and from donors who were identified to be hemodynamically unstable at the time of organ retrieval.
A prospective study was performed between July 1994 and March 1998, during which time 137 pancreas transplants were performed at our center using organs procured by our own surgeons (organs sent by other teams were excluded). The rapid en bloc technique was used exclusively. The use of pancreatic grafts from marginal donors was analyzed for short-term and overall graft survival, and for delayed graft function and complications.
Overall pancreas graft survival for our series was 83%, with a mean follow-up of 23 months. There were 22 pancreas grafts from donors over 45 years of age, 13 of whom were greater than 50 years of age. The actual graft survival rate of the over-45 donor group was 86%. Fifty-one grafts were removed from hemodynamically unstable donors on high-dose vasopressors. The actual graft survival in this group was 86%. There was no significant difference found in graft survival between recipients of pancreatic grafts from marginal and nonmarginal donors. Delayed graft function was exhibited by more recipients of grafts from donors on high-dose vasopressors (P<0.05), but this had no effect on long-term graft survival and endocrine function. Recipients of marginal donor grafts did not have higher rates of complication compared to recipients of nonmarginal grafts.
Based on our results, we currently employ a graft selection strategy not limited by donor age or hemodynamic stability. Our selection of pancreas organs for transplantation is based on careful inspection of the pancreas and determination of the adequacy of the ex vivo flush. Our results suggest that the current pancreas donor pool may be expanded substantially.
我们的器官获取组织被迫放宽供体标准，以扩大胰腺移植的供体库。在本报告中，我们描述了使用来自“边缘”供体的全器官胰腺移植物的经验，这些供体包括年龄超过45岁的供体以及在器官获取时被确定为血流动力学不稳定的供体。
于1994年7月至1998年3月进行了一项前瞻性研究，在此期间，我们中心使用由我们自己的外科医生获取的器官进行了137例胰腺移植（排除其他团队送来的器官）。仅使用了快速整块技术。分析了来自边缘供体的胰腺移植物的短期和总体移植物存活率，以及延迟移植物功能和并发症情况。
我们系列的总体胰腺移植物存活率为83%，平均随访23个月。有22例胰腺移植物来自年龄超过45岁的供体，其中13例年龄大于50岁。45岁以上供体组的实际移植物存活率为86%。51例移植物是从使用高剂量血管加压药的血流动力学不稳定供体获取的。该组的实际移植物存活率为86%。来自边缘和非边缘供体的胰腺移植物受者的移植物存活率没有显著差异。使用高剂量血管加压药的供体的移植物有更多受者出现延迟移植物功能（P<0.05），但这对长期移植物存活和内分泌功能没有影响。与非边缘移植物受者相比，边缘供体移植物受者的并发症发生率没有更高。
根据我们的结果，我们目前采用不受供体年龄或血流动力学稳定性限制的移植物选择策略。我们选择用于移植的胰腺器官是基于对胰腺的仔细检查以及确定体外冲洗是否充分。我们的结果表明，当前的胰腺供体库可能会大幅扩大。
