Prolonged Cold Ischemia Time in Pancreas Transplantation Yields Similar Outcomes Compared with Standard of Care Outcomes: Single-Center Experience, a Call to Action to Decrease Nonuse Rates

Background: Overall number of deceased donor pancreas transplant have decreased overtime and the rate of nonuse pancreas have reached its highest at 28.6% in 2022. There are many reason for nonuse pancreas, with newer allocation schemes, broader organ sharing, increase ischemia times, decrease risk tolerance and lack of center/surgeon expertise playing a role. We aim to evaluate our single center experience on the use of pancreas with prolonged cold ischemia time(CIT) and outcomes. Standard of care is to place the pancreas within 12 hours(hrs) of CIT. We report our single-center experience in the use of pancreas with over 12hrs of CIT. Methods: Single center retrospective review of all simultaneous kidney/pancreas(SPK) and pancreas transplant alone(PTA) from January 2014 to September 2023 with at least 6m of follow up. Pancreas graft failure was defined as allograft pancreatectomy or recipients' fully dependency of insulin and/or c-peptide levels <2.0 ng/ml Results: We had 190 SPK/PTA recipients during the study period, we divided them by less or more than 12hrs of pancreas CIT.Table1. Shortest CIT was 3.5hrs and longest was 23hrs, significantly higher among the groups (p<0.001).Enteric-drained recipients were more likely to have CIT<12hrs and bladder-drained more likely to have >12hr CIT (p<0.00001).Table2: Mean follow-up was longer in the group with >12hrs CIT, 5yrs vs 2.8 yrs (p=0.03). Patient survival was lower among the group with CIT>12hrs (p=0.007). However, there were no difference in pancreas graft survival among the groups. A1c,c-peptide and fasting blood glucose was similar up to 5yrs of follow-up. Conclusion: In the current environment of high nonuse rate for pancreas transplantation, allowing longer pancreas CIT and total pancreas preservation time, may increase the rates of pancreas transplantation. We are evaluating our outcomes with regards to post-op complications, enteric leak, intra-abdominal abscess and length of stay, between both groups, under and longer than 12hrs CIT.