Stegall Mark D, Dean Patrick G, Sung Randall, Guidinger Mary K, McBride Maureen A, Sommers Cindy, Basadonna Giacomo, Stock Peter G, Leichtman Alan B
Department of Surgery, Division of Transplantation Surgery, Mayo Clinic, Rochester, MN 55905, USA.
Transplantation. 2007 May 15;83(9):1156-61. doi: 10.1097/01.tp.0000261104.27113.05.
To ensure the continued success of whole organ pancreas and islet transplantation, deceased donor pancreas allocation policy must continue to evolve.
To assess the existing system, the Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing Kidney and Pancreas Transplant Committee retrospectively analyzed the disposition and outcomes of deceased donor pancreata in the United States between January 1, 2000 and December 31, 2003.
During the time period studied, consent was obtained but the pancreas was not recovered in 48% (11,820) of organ donors. The most common reasons given for nonrecovery were poor quality of the pancreas and difficulty in placement. Of whole organ pancreata that were transplanted, 90% were from donors with a body mass index (BMI) <or=30 kg/m and age <or=50 years. Pancreata from older and more obese donors were used more often for islet transplantation or research. For simultaneous pancreas-kidney transplants, the 1- and 3-year pancreas graft survival was lower when the donor was age >50 years (P=0.04), and there were trends toward lower graft survival with donor BMI >30 (P=0.06) and increasing cold-ischemia time.
Based on these data, the OPTN adopted a new allocation algorithm in which pancreata from donors >30 kg/m or >50 years of age are, unless accepted for a local whole organ pancreas transplant candidate, preferentially allocated for islet transplantation. These data also suggest that many good quality pancreata are not procured, emphasizing the need for improved communication and cooperation between organ procurement organizations and pancreas and islet transplant programs.
为确保全胰腺和胰岛移植的持续成功，已故供体胰腺分配政策必须不断发展。
为评估现有系统，器官获取与移植网络（OPTN）/器官共享联合网络肾脏和胰腺移植委员会回顾性分析了2000年1月1日至2003年12月31日期间美国已故供体胰腺的处置情况和结果。
在研究期间，48%（11,820例）的器官捐献者获得了同意但胰腺未被获取。未获取的最常见原因是胰腺质量差和放置困难。在移植的全胰腺中，90%来自体重指数（BMI）≤30 kg/m且年龄≤50岁的供体。年龄较大和肥胖程度较高的供体的胰腺更多地用于胰岛移植或研究。对于同期胰肾联合移植，当供体年龄>50岁时，1年和3年胰腺移植物存活率较低（P = 0.04），并且随着供体BMI>30（P = 0.06）和冷缺血时间增加，移植物存活率有降低趋势。
基于这些数据，OPTN采用了一种新的分配算法，即除非被当地全胰腺移植候选人接受，否则来自BMI>30 kg/m或年龄>50岁供体的胰腺将优先分配用于胰岛移植。这些数据还表明许多质量良好的胰腺未被获取，强调了器官获取组织与胰腺和胰岛移植项目之间改善沟通与合作的必要性。
