Professor of Surgery
Surgery, Westmead Clinical School
Geographic distance does not preclude successful transplantation across the Australian continent
Sara Shahrestani1, Demi Beneru1, Vincent An1, Hannah Rayner1, Wayne J Hawthorne1,2,3, Henry Pleass1,3.
1Westmead Clinical School, Sydney Medical School, University of Sydney, Westmead, Australia; 2The Centre for Transplant & Renal Research, Westmead Millennium Institute, Westmead, Australia; 3Surgery, Westmead Hospital, Westmead, Australia
Aim: The Australian continent spans over 4,000km and coordination of organ donation surgery and transportation of the organ presents logistic challenges. Importantly, the cold ischemic time the organ undergoes while being transported long distances can potentially influence outcomes from resultant ischaemic damage. The aims of the present study were to explore whether geographic origin of pancreas donation and the cold ischemic time (CIT) can influence short and long-term outcomes for simultaneous pancreas-kidney transplants based on origin state.
Methods: We conducted a retrospective review of patient data collected between 2011-2014 at Westmead Hospital, consisting of 96 simultaneous pancreas-kidney transplant patients. We conducted ANOVA, multiple and logistic regression analyses using SPSS software to assess whether factors such as donor state of origin or CIT predict transplant outcomes and complications at the time points 1 month, 3 months and 1 year after the transplant. We assessed outcomes and complications by reviewing recipient urea, creatinine, amylase and glucose at these time points.
Results: Our dataset reviewed 96 SPK recipients of which 38.5% were female and the mean age of recipients was 37. The mean age of donors was 28. Our analysis revealed that the geographic origin of organs by state was not an accurate predictor of the cold ischemic time and thus geography is unlikely to be a limiting factor in organ donation. When we analysed donor state to see if it could accurately predict cold ischemic time we found that geographically distant donor states provided donor organs more rapidly than closer states. Specifically organs from Queensland (738min), South Australia (733min) and Victoria (742min) were associated with longer cold ischemic times than Western Australia (689min). Despite this, we found no significant differences between in graft outcomes from the various states in terms of complications such as rejection rate, return to theatre or graft function measured by urea, creatinine, amylase and glucose measured at 1 month, 3 months and 1 year after the transplant (p>0.05), aside from 1 month urea (p=0.021) which later normalised. Likewise, we found CIT independently was not a good marker of transplant outcome or graft function for the same measures (p>0.05) and future works should examine this further.
Conclusions: Despite the vast distances across the Australian continent and variations in CIT we found successful outcomes from pancreas retrieval and transplantation were possible from donors in all states. However, obvious improvements could be made to decrease potential CIT from some states. Geographic distance does not play a role in determining graft function or transplant outcome.
13:00 - 16:15
|Pancreas Transplantation: Global Trends in Pancreas Transplantation – challenges and opportunities||Global trends in Pancreas Transplantation – Regional reports: Australia||Room 110|
15:30 - 17:00
|Pancreas & Islet Donors: Assessing Risk and Optimizing Outcomes||Geographic distance does not preclude successful transplantation across the Australian continent||Room 110|