Department of Organ Transplant Surgery
Fujita Health University, School of Medicine
Outcome of Pancreas Transplantation from Deceased Donors in Japan. - Japanaese Registry Data -
Takashi Kenmochi5, Toshinori Ito1, Ichiro Nakajima2, Hidehisa Kitada3, Mitsukazu Goto4.
1Department of Surgery, Osaka University, School fo Medicine, Osaka, Japan; 2Department of Surgery, Tokyo Woman's Medical University, Tokyo, Japan; 3Departmernt of Surgery, Kyushu University, School of Medicine, Fukuoka, Japan; 4Department of Surgery, Fukishima Medical University, School of Medicine, Koriyama, Japan; 5Department of Organ Transplant Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
Since the Organ Transplant Law was enforced in 1997, 237 pancreas transplantations(PTx) [208; from brain dead donors(DBD), 2; non heart beating donors(DCD), 27; from live donors(LD)] were performed from 2000 to 2014 in Japan. Since August in 2010, the number of PTxs from DBD donors has vastly been increased because of the amendment of the Organ Transplant Law. In this study, we evaluated the effectiveness of 210 PTxs from deceased donors by analyzing the data both of the donor and the recipient.
198 type 1 diabetic patients are now registered on the waitign list of pancreas transplantation of Japan Organ Transplant Network. Fifty three patients have, so far, died of hypoglycemia or other reasons during waiting period. Out of 210 PTxs, 114 donors (54%) were over 40 years, which was older as compared to the US and Europe. The Cause of death was cerebrovascular diseases in 116 donors (55%). According to the criteria by Kapur, 170 donors (81%) in our series were considered to be marginal donors. Cold ischemic time was 11 hours 53 minutes (mean) in pancreas and 10 hours 48 minutes in kidney. For the safe use of marginal pancreas, we reconstruct the blood vessels of the graft using donor Y-graft or I-graft before transplantation.
Category of PTxs were SPK; 167 (79.5%), PAK; 32 (15.2%) and PTA; 11 (5.2%). The duration of insulin therapy and hemodialysis of the recipients were 27.4 and 6.9 years. Waiting period was 1,312 days (mean). The number of HLA mismatch was 2.62. Induction therapy by @IL-2R or ATG was performed in 203 patients (97%) and immunosuppression was maintained by tacrolimus (98%) or cyclosporin (2%) combined with MMF and steroid. Enteric drainage was selected in 174 patients (83%) and bladder drainage in 36 patients (17%). Main complications after PTx were vessel's thrombosis, bleeding and ileus. 5-year recipient survival was 95.8%. Pancreas graft survivals,. which were defined to be more than 0.3ng/ml of serum C-peptide level, were 84.7% at 1-year, 77.0% at 5-year and 70.4% at 10-year. While, kidney graft survivals were 92.5% at 1- and 5-year, and 89.2% at 10-year, respectively(Fig.1).
Although majority of the deceased donors were marginal in our country, clinical outcome of PTxs demonstrated that PTx was a potent and promising treatment for severe type 1 diabetic patients also in Japan.
15:30 - 17:00
|Pancreas & Islet Donors: Assessing Risk and Optimizing Outcomes||Outcome of Pancreas Transplantation from Deceased Donors in Japan - Japanese Registry Data -||Room 110|