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Impact of Deceased Donor Cardiac Arrest Time on Postpancreas Transplant Graft Function and Survival

INTRODUCTION: Transplantation of pancreas allografts from donors that have experienced preprocurement cardiopulmonary arrest (PPCA) is not common, though use of PPCA grafts is routine in liver and kidney transplantation. This article reviews a large number of PPCA pancreas grafts at a single center...

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Autores principales: Schroering, Joel R., Mangus, Richard S., Powelson, John A., Fridell, Jonathan A.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133408/
https://www.ncbi.nlm.nih.gov/pubmed/30234150
http://dx.doi.org/10.1097/TXD.0000000000000813
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author Schroering, Joel R.
Mangus, Richard S.
Powelson, John A.
Fridell, Jonathan A.
author_facet Schroering, Joel R.
Mangus, Richard S.
Powelson, John A.
Fridell, Jonathan A.
author_sort Schroering, Joel R.
collection PubMed
description INTRODUCTION: Transplantation of pancreas allografts from donors that have experienced preprocurement cardiopulmonary arrest (PPCA) is not common, though use of PPCA grafts is routine in liver and kidney transplantation. This article reviews a large number of PPCA pancreas grafts at a single center and reports posttransplant outcomes including early graft dysfunction, length of hospital stay, rejection, and early and late graft survival. METHODS: Preprocurement cardiopulmonary arrest, arrest time, and donor and recipient pancreatic enzyme levels were collected from electronic and written medical records. The PPCA donors were stratified into 4 groups: none, less than 20 minutes, 20-39 minutes, and 40 minutes or greater. Graft survival was assessed at 7 and 90 days and at 1 year. Long-term graft survival was assessed by Cox regression analysis. RESULTS: The records of 606 pancreas transplants were reviewed, including 328 (54%) simultaneous pancreas and kidney transplants. Preprocurement cardiopulmonary arrest occurred in 176 donors (29%; median time, 20 minutes). Median peak donor lipase was higher in PPCA donors (40 μ/L vs 29 μ/L, P = 0.02). Posttransplant, peak recipient amylase, and lipase levels were similar (P = 0.63). Prolonged arrest time (>40 minutes) was associated with higher donor peak lipase and lower recipient peak amylase (P = 0.05 for both). Stratified by donor arrest time, there was no difference in 7-day, 90-day, or 1-year graft survival. Cox regression comparing the 4 groups demonstrated no statistical difference in 10-year survival. CONCLUSIONS: These results support transplantation of pancreas allografts from PPCA donors. Prolonged asystole was associated with higher peak donor serum lipase but lower peak recipient serum amylase. There were no differences in allograft survival.
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spelling pubmed-61334082018-09-19 Impact of Deceased Donor Cardiac Arrest Time on Postpancreas Transplant Graft Function and Survival Schroering, Joel R. Mangus, Richard S. Powelson, John A. Fridell, Jonathan A. Transplant Direct Pancreas and Islet Transplantation INTRODUCTION: Transplantation of pancreas allografts from donors that have experienced preprocurement cardiopulmonary arrest (PPCA) is not common, though use of PPCA grafts is routine in liver and kidney transplantation. This article reviews a large number of PPCA pancreas grafts at a single center and reports posttransplant outcomes including early graft dysfunction, length of hospital stay, rejection, and early and late graft survival. METHODS: Preprocurement cardiopulmonary arrest, arrest time, and donor and recipient pancreatic enzyme levels were collected from electronic and written medical records. The PPCA donors were stratified into 4 groups: none, less than 20 minutes, 20-39 minutes, and 40 minutes or greater. Graft survival was assessed at 7 and 90 days and at 1 year. Long-term graft survival was assessed by Cox regression analysis. RESULTS: The records of 606 pancreas transplants were reviewed, including 328 (54%) simultaneous pancreas and kidney transplants. Preprocurement cardiopulmonary arrest occurred in 176 donors (29%; median time, 20 minutes). Median peak donor lipase was higher in PPCA donors (40 μ/L vs 29 μ/L, P = 0.02). Posttransplant, peak recipient amylase, and lipase levels were similar (P = 0.63). Prolonged arrest time (>40 minutes) was associated with higher donor peak lipase and lower recipient peak amylase (P = 0.05 for both). Stratified by donor arrest time, there was no difference in 7-day, 90-day, or 1-year graft survival. Cox regression comparing the 4 groups demonstrated no statistical difference in 10-year survival. CONCLUSIONS: These results support transplantation of pancreas allografts from PPCA donors. Prolonged asystole was associated with higher peak donor serum lipase but lower peak recipient serum amylase. There were no differences in allograft survival. Lippincott Williams & Wilkins 2018-08-21 /pmc/articles/PMC6133408/ /pubmed/30234150 http://dx.doi.org/10.1097/TXD.0000000000000813 Text en Copyright © 2018 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (http://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Pancreas and Islet Transplantation
Schroering, Joel R.
Mangus, Richard S.
Powelson, John A.
Fridell, Jonathan A.
Impact of Deceased Donor Cardiac Arrest Time on Postpancreas Transplant Graft Function and Survival
title Impact of Deceased Donor Cardiac Arrest Time on Postpancreas Transplant Graft Function and Survival
title_full Impact of Deceased Donor Cardiac Arrest Time on Postpancreas Transplant Graft Function and Survival
title_fullStr Impact of Deceased Donor Cardiac Arrest Time on Postpancreas Transplant Graft Function and Survival
title_full_unstemmed Impact of Deceased Donor Cardiac Arrest Time on Postpancreas Transplant Graft Function and Survival
title_short Impact of Deceased Donor Cardiac Arrest Time on Postpancreas Transplant Graft Function and Survival
title_sort impact of deceased donor cardiac arrest time on postpancreas transplant graft function and survival
topic Pancreas and Islet Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133408/
https://www.ncbi.nlm.nih.gov/pubmed/30234150
http://dx.doi.org/10.1097/TXD.0000000000000813
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