National Institute for Health and Care Excellence (NICE) guidelines for allogeneic pancreatic islet cell transplantation (NICE [IPG257] 2008) and autologous pancreatic islet cell transplantation following pancreatectomy (NICE [IPG274] 2008) have been published.
Pancreas transplantation remains the only curative treatment for patients with juvenile diabetes. Severe morbidity and mortality are associated with the long waiting lists due to organ shortage and restrictive allocation criteria. A prospective, multicentre trial (Proneth et al., 2018) was therefore set up to investigate extended-donor criteria (EDC) organs (donor age, 50–60 years; body mass index, 30–34 kg/m2). Seventy-nine patients were included in 12 German centres; 18 received EDC organs and 61 received standard organs (control group). Recipient demographics were similar. Mean EDC donor age was 51.4 ± 5 years versus 31.7 ± 12 in the control group. Insulin-free graft survival was 83.3% for EDC and 67.2% for standard organs (p=0.245) after 3 months. One-year pancreas survival was 83.3% and 83.5% in the EDC versus standard control group. One-year kidney allograft survival was approximately 94% in both groups. Rejection episodes and morbidity were similar for EDC and standard organs.
This prospective trial (Proneth et al., 2018) has shown that selected EDC organs of donors older than 50 years can be used with outcomes similar to standard-criteria organs. The results of the study support the full implementation of EDC organs in a pancreas allocation system with the potential to reduce organ shortage and waiting times.