Operative Care Division, Section of Surgical Critical Care, VA Portland Health Care System, Portland, Oregon.
Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, Oregon.
Clin Transplant. 2019 Jun;33(6):e13571. doi: 10.1111/ctr.13571.
Criteria for organ acceptance in brain-dead organ donors remain inconsistent, especially when concerning pancreatic transplants. We sought to examine donor-specific predictors of pancreatic graft use and survival to better guide the selection and management of potential donors. A prospective observational study of all donors from ten organ procurement organizations was conducted from March 2012 to January 2015. Critical care endpoints were collected at 4 standardized time points. Data associated with pancreatic transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. From 1819 donors, 238 (13.1%) pancreata were transplanted, and at a mean follow-up of 192 days, 218 (91.6%) grafts had survived. After regression analysis, donor age (OR = 0.89), HgbA1C (OR = 0.07), and achieving the donor management goal (DMG) for ejection fraction at allocation of ≥50% (OR = 3.29) remained as independent predictors of pancreatic utilization. On regression analysis, graft survival was independently predicted by lower donor age (OR = 0.93) and achieving the DMGs for mean arterial pressure (60-110 mm Hg) and glucose (≤180 mg/dL) at separate time points. These results may help guide the management and selection of potential pancreatic donors after brain death.
脑死亡器官捐献者的器官接受标准仍然不一致，尤其是在胰腺移植方面。我们旨在研究供体特异性预测因子对胰腺移植物使用和存活的影响，以便更好地指导潜在供体的选择和管理。对来自 10 个器官获取组织的所有供体进行了前瞻性观察研究，研究时间为 2012 年 3 月至 2015 年 1 月。在 4 个标准化时间点收集了重症监护终点数据。首先使用单变量分析确定与胰腺移植和移植物存活率相关的数据，然后使用逻辑回归确定这两个结果的独立预测因子。在 1819 名供体中，有 238 名（13.1%）胰腺被移植，在平均随访 192 天后，有 218 名（91.6%）移植物存活。经过回归分析，供体年龄（OR=0.89）、糖化血红蛋白（HbA1C）（OR=0.07）和在分配时达到射血分数≥50%的供体管理目标（DMG）（OR=3.29）仍然是胰腺利用的独立预测因子。在回归分析中，移植物存活独立于较低的供体年龄（OR=0.93）和在单独的时间点达到 DMG 时的平均动脉压（60-110mmHg）和血糖（≤180mg/dL）。这些结果可能有助于指导脑死亡后潜在胰腺供体的管理和选择。
