A Composite Risk Model for Predicting Technical Failure in Pancreas Transplantation

• Published in: American journal of transplantation Vol. 13; no. 7; pp. 1840 - 1849
• Main Authors: Finger, E. B., Radosevich, D. M., Dunn, T. B., Chinnakotla, S., Sutherland, D. E. R., Matas, A. J., Pruett, T. L., Kandaswamy, R.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01.07.2013; Wiley Subscription Services, Inc
• Subjects: Biological and medical sciences; Cost; Epidemiology; Female; Follow-Up Studies; General aspects; Graft Rejection - epidemiology; Graft Rejection - etiology; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Pancreas; Pancreas Transplantation; Public health. Hygiene; Public health. Hygiene-occupational medicine; Registries; Retrospective Studies; Risk Assessment - methods; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; survival; Survival Rate - trends; technical failure; Tissue and Organ Procurement - standards; transplant; Transplants & implants; Treatment Failure; United States - epidemiology; United States; Composite graft; Costs; risk factors; Prognosis; Risk; Transplantation; Homotransplantation; Epidemiology; Survival; Cost; technical failure; Treatment; Surgery; Health economy; Risk factor; Graft; transplant; Models; Economic aspect; Technique; Pancreas; Failure; Public health
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.12269

Technical failure (TF) continues to have a significant impact on the success of pancreas transplantation. We assessed risk factors for TF in 1115 pancreas transplants performed at a single center between 1998 and 2011. The overall TF rate was 10.2%. In a multivariable model, donor BMI ≥30 (HR 1.87, p = 0.005), donor Cr ≥2.5 (HR 3.16, p = 0.007), donor age >50 (HR 1.73, p = 0.082) and preservation time >20 h (HR 2.17, p < 0.001) were associated with TF. Bladder drainage of exocrine secretions was protective (HR 0.54, p = 0.002). We incorporated these factors in a Composite Risk Model. In this model the presence of one risk factor did not significantly increase risk of TF (HR 1.35, p = 0.346). Two risk factors in combination increased risk greater than threefold (HR 3.65, p < 0.001) and three risk factors increased risk greater than sevenfold (HR 7.66, p = <0.001). The analysis also identified many factors that were not predictive of TF, including previous transplants, immunosuppressive agent selection, and almost all recipient demographic parameters. While the model suggests that two or more risk factors predict TF, strategies to reduce preservation time may mitigate some of this risk. This study examines risk factors for technical failure in pancreas transplantation and identifi es four main parameters (donor age > 50, donor terminal Cr ≥ 2.5, donor BMI > 30, and preservation time > 20 hours), which alone or in combination signifi cantly increases risk for technical failure.