Donor insulin use during stay in the intensive care unit should not preclude pancreas transplantation

Excerpt

To the Editor: In a recent issue of Diabetologia, Shapey et al reported the short-term outcomes of pancreas transplantation with organs from donors who required insulin use during their period of stay on the intensive care unit (ICU) prior to pancreas donation [1]. The major finding of this retrospective registry analysis was a direct relationship between donor insulin use (DIU) and an increased risk for early graft failure due to isolated islet failure (OR 1.79 [95% CI 1.05, 3.07]). This is a major topic in the pancreas transplant community since islet cell damage induced by brain-death or pre-procurement therapies may present an add-on risk for graft failure to that associated with ischaemia-reperfusion-induced injury and post-transplant steroid and immunosuppression treatment. Nonetheless, the conclusions should be read with caution due to some methodological biases, and the extrapolation of the results towards decision taking (e.g., by transplant teams when deciding whether to accept or discard a pancreas for transplantation) should be done with care due to the concerns outlined below. …