Pancreas Transplants from small donors: are the outcomes acceptable?

Despite good organ quality, pancreata from extremely small pediatric donors (<30kg) are generally avoided by many centers due to concerns of reduced islet cell mass and early technical failure. Therefore, we sought to compare the outcomes of small pancreas grafts (<30 kg) to those from higher weight donors from transplants performed between 1994-2015 (n=1183). A total of 33 pancreata were from donors' ≤30 kg (3%), with a mean weight of 23.8 kg and mean age of 7.8 yrs. Patient survival was similar at 1, 5 and 10 years between recipients of ≤30 kg and >30 kg donors (≤30 kg: 96.8%, 86.8%, 78.1% vs. >30 kg: 96.8%, 89.5%, 79.1%, p=0.5). Pancreas graft survival at 1, 5 and 10 years was also similar, ≤30 kg: 93.9%, 73.2%, 61.0% vs. >30kg: 87%, 73.3%, 58.3% (p=0.7). This graft survival pattern was also seen when comparing pancreata from ≤20 kg donors to those from >20-30 kg. Cause of graft loss, Metabolic, and physiologic outcomes did not differ between the groups. After assessing the impact of donor weight as a continuous variable, and calculating recipient to donor weight ratio (RDWR), we observed no effect of donor weight on patient and graft outcomes.