Introduction: The success of pancreas transplantation, in combination with a stable number of available allografts has resulted in an increasing waiting list. This study investigated donor... Show moreIntroduction: The success of pancreas transplantation, in combination with a stable number of available allografts has resulted in an increasing waiting list. This study investigated donor potential by expanding age and Body Mass Index (BMI) criteria.Methods: All reported donors in the Netherlands between 2013 and 2017 were analysed. Risk assessment of extended criteria donors was done by in-depth analysis of donor reports and calculation of the Pancreas Donor Risk Index (PDRI). The PDRI of these extended criteria donors was compared to standard criteria donors to evaluate the increased risk on graft failure.Results: A total of 1273 donors were reported. Of these donors, 405 donors were reported as pancreas donor, of which 93 (23%) pancreata were transplanted. Extending age criterion with 5 years could result in additional 40 Donation after Brain Death donors and 37 Donation after Circulatory Death donors reported. In 24 (31%) extended age criteria donors the PDRI was below the upper limit of currently transplanted pancreata. Extending BMI criteria to 35 kg/m(2) could result in an additional 19 (6%) donors reported.Conclusions: Extending BMI criteria could result in a slight increase of reported donors. Extending age criteria increased significantly the number of reported donors. In 24 (31%) of the older donors the PDRI showed a reduced risk compared to currently transplanted pancreata. This study suggest that, if other risk factors are absent, pancreata of extended age and/or BMI criteria donors should be considered for transplantation. (C) 2019 IAP and EPC. Published by Elsevier B.V. All rights reserved. Show less
Pancreas transplantation is the only long-lasting curative option patients with type 1 diabetes mellitus. During the last 50 years, it has evolved from an experimental procedure to an accepted... Show morePancreas transplantation is the only long-lasting curative option patients with type 1 diabetes mellitus. During the last 50 years, it has evolved from an experimental procedure to an accepted treatment. For patients suffering from diabetes mellitus induced end-stage renal disease, a simultaneous pancreas-kidney transplantation is the best option. Due to increased experience, the indications for transplantation have been expanded, causing waiting lists to increase. To match the increasing demand, transplant professionals are forced to accept higher risk donor organs. This thesis investigates those risks and aims to quantify the risk in donor risk indices. Those risk indices were also investigated in this thesis. Furthermore, solitary risk factors for outcome were investigated. There appears to be a significant association between center volume and outcome: high volume center have better results than low volume centers, despite accepting higher risk donor organs. Another risk factor that was investigated was donation after circulatory death (DCD) pancreas transplantation. It showed that DCD pancreas transplantation is a feasible option to expand the donor pool. Show less
