Optimization the use of pancreatic grafts in Brazil

Abstract

Liver and kidney grafts have been more optimized than pancreas grafts worldwide. This review aims to show strategies of using non- ideal pancreatic donors in order to increase the amount of organs for pancreas transplantation in Brazil. Non-ideal donors for pancreas transplantation include those with hyperamylasemia, hyperglycemia, using vasopressors, and the pediatric, old, obese and non-heart-beating donors, as well as donors with vascular abnormality or donors with congenital abnormalities in the graft. Donors should not be excluded based only on their age, weight, blood tests or due to the use of vasoactive drugs. Importantly, the inspection and palpation of the pancreas by an experienced surgeon will be the determinant factor to the feasibility for the organ donation for islet or pancreas transplantation. During the donor surgery, vascular abnormalities as well as the simultaneous donation of the liver and/or the small bowel should not preclude the pancreas donation. The presence of fat infiltration, fibrosis, atherosclerosis, and the renal function of the donor, as well as a proper selection of the recipient are the main factors to be used to determine whether marginal donors will be used or not for the pancreas or islet transplantation. Organs that should not be used for pancreas transplantation might be used for islet transplantation. An aggressive policy can significantly raise the number of pancreas available for transplantation in our country.