Pancreas Donor Risk Index but Not Pre-Procurement Pancreas Allocation Suitability Score Predicts Pancreas Graft Survival: A Cohort Study from a Large German Pancreas Transplantation Center

BACKGROUND: The pre-procurement pancreas allocation suitability score (P-PASS) was introduced to support clinical decision-making and ultimately expand the currently insufficient pancreas donor pool. The pancreas donor risk index (PDRI) can be used at the time of organ offering to predict one-year graft survival. Thus, this study aimed to analyze the validity of the PDRI and P-PASS in a large German transplant center. MATERIAL/METHODS: From 2002 to 2015, we performed 327 pancreas transplantations at our center. P-PASS and PDRI were calculated for 322 patients. To evaluate the pancreas graft survival, the patient cohort was divided into 2 P-PASS (<17, n=115 and ≥17, n=207) and 3 PDRI groups (<1, n=87; 1–1.5, n=133; and >1.5, n=102). Kaplan-Meier and Cox regression analyses were performed. We also examined differences regarding early pancreas graft failure for both scores using the chi-square test. RESULTS: The PDRI was associated with pancreas graft survival in the univariate analysis (p=0.023). In the multivariate analysis, a PDRI >1.5 was associated with significantly decreased graft survival (hazard ratio=1.792, 95% confidence interval=1.10–2.90, p=0.018). The P-PASS showed no significant association (p=0.081) with pancreas graft survival in the Kaplan-Meier survival analysis. There were significantly more early pancreas graft losses in the P-PASS ≥17 group (p=0.025). CONCLUSIONS: Our results showed an association between P-PASS ≥17 and early pancreas graft failure. However, this does not apply to long-term pancreas graft survival; the PDRI proved to be a better tool for this, and PDRI values >1.5 were associated with significantly worse outcomes after pancreas transplantation.