Pancreas donor quality and donor risk indices in pancreas allocation in the Eurotransplant region

C.A.T. van Leeuwen, W.H. Kopp, E. de Vries, J. de Boer, H. Putter, W. Schareck, U. Samuel, A.E. Braat

Chair(s): dr. Dennis A. Hesselink, internist-nefroloog, Erasmus MC & dr. Marieke Roemeling, internist i.o., UMC Groningen

Wednesday 9 march 2016

16:50 - 17:00h at Zaal 1 & 2

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie V - Klinisch

Pancreas donor selection and recognition, as well as optimal organ allocation are important to cope with increasing organ shortage. The Pancreas Donor Risk Index (PDRI) might be a useful tool, however contains logistical factors that do not necessarily reflect donor quality. The Preprocurement Pancreas Allocation Suitability Score (P-PASS) was developed in 2008 to predict pancreas acceptance and might not be fully applicable.

All donors reported to Eurotransplant from 2004 until 2014 were included. PDRI logistical factors were set to reference, to purely reflect donor quality (PDRIdonor). PDRI and P-PASS association with allocation outcome was studied using area under the receiver operating characteristic curve (AUROC). Regional differences in donor quality were also investigated.

In the study period 23 851 donors, of which 10 444 pancreas donors, were reported. From 6090 (58.3%) donors the pancreas was accepted by a transplant center and from 2947 (28.2%) donors the pancreas was transplanted. P-PASS was inferior to PDRIdonor in its ability to predict organ reporting, acceptance and transplantation: AUC 0.63, 0.67 and 0.73 for P-PASS vs. 0.78, 0.79 and 0.84 for PDRIdonor, respectively. Furthermore, there were significant differences in donor quality amongst the different Eurotransplant countries, both in reported donors, as well as in transplanted organs.

PDRI is a powerful predictor of allocation outcome and should be preferred over P-PASS. Proper donor selection and recognition and possibly a more liberal approach towards inferior quality donors may increase donation and transplantation rates.