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. 2024 May 20:37:12864.
doi: 10.3389/ti.2024.12864. eCollection 2024.

Donor Blood Tests do Not Predict Pancreas Graft Survival After Simultaneous Pancreas Kidney Transplantation; a National Cohort Study

Ning Xuan Ho #  1 , Samuel J Tingle #  1   2 , Abdullah K Malik  1   2 , Emily R Thompson  1   2 , Georgios Kourounis  1   2 , Aimen Amer  1   2 , Sanjay Pandanaboyana  1   2 , Colin Wilson  1   2 , Steve White  1   2
Affiliations

Donor Blood Tests do Not Predict Pancreas Graft Survival After Simultaneous Pancreas Kidney Transplantation; a National Cohort Study

Ning Xuan Ho et al. Transpl Int. .

Abstract

Simultaneous pancreas-kidney (SPK) transplantation improves quality of life and limits progression of diabetic complications. There is reluctance to accept pancreata from donors with abnormal blood tests, due to concern of inferior outcomes. We investigated whether donor amylase and liver blood tests (markers of visceral ischaemic injury) predict pancreas graft outcome using the UK Transplant Registry (2016-2021). 857 SPK recipients were included (619 following brainstem death, 238 following circulatory death). Peak donor amylase ranged from 8 to 3300 U/L (median = 70), and this had no impact on pancreas graft survival when adjusting for multiple confounders (aHR = 0.944, 95% CI = 0.754-1.81). Peak alanine transaminases also did not influence pancreas graft survival in multivariable models (aHR = 0.967, 95% CI = 0.848-1.102). Restricted cubic splines were used to assess associations between donor blood tests and pancreas graft survival without assuming linear relationships; these confirmed neither amylase, nor transaminases, significantly impact pancreas transplant outcome. This is the largest, most statistically robust study evaluating donor blood tests and transplant outcome. Provided other factors are acceptable, pancreata from donors with mild or moderately raised amylase and transaminases can be accepted with confidence. The use of pancreas grafts from such donors is therefore a safe, immediate, and simple approach to expand the donor pool to reach increasing demands.

Keywords: SPK transplantation; donor blood tests; graft surival; organ utilisation; pancreas transplantation; registry study.

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Conflict of interest statement

Author ST worked on this project during an MRC Clinical Research Training Fellowship (MR/Y000676/1) at Newcastle University. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Donor peak amylase and peak alanine transaminase (ALT) distribution. (A,B) demonstrates values of peak amylase across the entire cohort displayed in histogram and violin plot respectively. (C,D) shows values of peak ALT across the entire cohort displayed in histogram and violin plot respectively.
FIGURE 2
FIGURE 2
The impact of peak donor Amylase (A) and ALT (B) on graft survival using cox regression models with restricted cubic splines. The shaded area represents the 95% confidence interval, and a dashed line at 1 represents no impact on outcome. For comparison, a separate model was performed for recipient age (C), which showed that younger recipients have worse outcome. ALT, alanine transaminase.
FIGURE 3
FIGURE 3
Kaplan-Meier plot showing graft survival based on donor peak amylase level. Only those with complete amylase and graft survival data are shown.
See this image and copyright information in PMC

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