Introduction: Simultaneous kidney and pancreas transplantation (SPKT) is gold standard for management of ESRD due to type 1 Diabetes. Mortality on waitlist for some SPKT is as high as 7 deaths per 100 waitlist years in US. The usage of pancreas from DCD donors is increasing to meet the organ demand. Recent outcome studies of DCD and DBD donors have shown comparable graft and patient survival in both cohorts. Despite this, clinician reticence remains due to a perceived higher risk of complications in SPKT from DCD donors. The aim of our study was to compare the outcomes of SPKT from DBD and DCD donor in our cohort.
Methods: Single centre, retrospective observational study was performed at Manchester Royal Infirmary where patients who underwent SPKT between January 2010 and January 2020 were analysed. Patients having pancreas transplant alone, pancreas after kidney transplant and Islet transplant were excluded from the study. Statistical analyses were done using latest version of SPSS.
Results: Out of total 312 patients analysed, 209 patients had DBD SPKT, and 109 patients had DCD SPKT. Donor age was significantly higher in the DBD group (34.34 +/- 13.7 years) compared to DCD (28.07 +/-12.7 years) group (p<0.05). Other donor demograhic variables (Sex, BMI, and cause of death) were comparable between the two groups. In the recipients, apart from recipients receiving SPKT from DBD donors having spent longer time on the waiting list (564.31 vs 350.24 days, p:0.019) there were no differences in other demograhic characteristics.
Two -year death censored pancreas graft survival was better in the DCD group p:0.04[ZM2] ). The cause of death included cerebrovascular accident, multisystem failure, sudden cardiac event and unknown causes. 83.4% patients had functioning kidney graft two years after transplant in DCD group compared to 76.07%  in DBD group . The difference was statistically significant. (p 0.02).
Conclusion: This study reiterates that pancreata from DCD donors are a valuable resource in SPKT with comparable outcomes. The superior pancreas graft outcomes in our DCD cohort may be related to the difference in donor age between the DBD suggesting more selective acceptance of pancreas from DCD donors. Despite being a single centre study, the large cohort of DCD SPKT performed with good outcomes should further reinforce the safety and efficacy pancreas transplantation from DCD donors.