The impact of delayed graft function after pancreas transplantation on clinical outcomes and survival

INTRODUCTION: Delayed graft function after pancreas transplantation (pDGF) is still lacking of a homogenous definition. So, its incidence and clinical impact are poorly understood.

METHODS: 151 consecutive pancreas transplants (PTx) performed at the Medical University of Innsbruck between January 2011 and December 2021. 142 were finally evaluated analyzed after excluding those with early graft loss due to surgical or infectious problems.

RESULTS: pDGF was defined as a total mean insulin requirement of 2.5 UI or greater within postoperative day 10. Of the 142 recipients, 52 (36.6 %) developed pDGF. By multivariate analysis, pDGF was found to be associated with a donor age (odds ratio, 1.05; 95 % CI: 1.01-1.09; p = 0.010) and the continuous postoperative administration of unfractioned heparin (odds ratio, 2.52; 95 % CI: 1.12-5.64; p = 0.025). The occurrence of pDGF lead to longer hospital stay (23 vs 20 days, p = 0.049), intensive care unit stay (5 vs 3 days, p < 0.003) and impaired glycemia at day 10 postoperative (146.0 vs 126.4 mg/dl, p < 0.001). Also, pDGF was found to be associated with a greater risk of pancreas graft failure at 5 years (p = 0.047) in the univariable analysis, while in the multivariable this trend was not statistically significant (p = 0.076). Of note, in the multivariable analysis pDGF showed a strong trend towards worse graft survival without reaching statistical significance (HR:2.33, 95 % CI: 0.95-5.82; p = 0.069) CONCLUSION: pDGF represents a common condition, depending both from donor and recipient conditions. Its clinical impact concerns the early postoperative stay and the long-term graft survival as well.