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Adverse Occurrence type:
Investigated postdonation outcomes in 46 living segmented pancreas donors. Postoperative complications included: 6 (13%) peripancreatic fluid collections and 2 (4%) pancreatitis episodes. Cumulative incidence of splenectomy was 20%; 5 (11%) donors underwent splenectomy at the time of donation and 4 (9%) required splenectomy during the reexploration for splenic infarct. Postdonation, diabetes mellitus requiring oral hypoglycemics was diagnosed in 7 (15%) donors and insulin-dependent DM in 5 (11%) donors. Quality of life was not significantly affected by donation.
Time to detection:
Postoperative complications were detected immediately or in the few days post-surgery. Postdonation diabetes mellitus requiring oral hypoglycemic management was identified in a mean time of onset postdonation of 9.2 (±3.3) years (range, 5-14.8 years). Insulin-dependent DM was identified in a mean time of onset postdonation 7 (±5.4) years (range, 0.5-12.8 years).
Alerting signals, symptoms, evidence of occurrence:
Relative risk factors for postdonation diabetes mellitus included -predonation FPG of 100 mg/dL or greater, -basal insulin of 9 μU/mL or greater -OGTT 2 h of 120 mg/dL or greater -postdonation ΔBMI greater than 15% Relative risks ranged from 4.6 to 6 with high specificity (0.82-1), but low sensitivity. Using these risk factors, a risk stratification model was created and showed that presence of 2 or more risk factors was associated with 100% rate of becoming diabetic postdonation. None of the donors with “0” risk factors became diabetic.
Demonstration of imputability or root cause:
Development of a risk stratification model that used pre, and shortly postdonation risk factors to predict development of diabetes.
Suggest new keywords:
Living pancreas donation
Kirchner VA, Finger EB, Bellin MD, Dunn TB, Gruessner RW, Hering BJ, Humar A, Kukla AK, Matas AJ, Pruett TL, Sutherland DE, Kandaswamy R. Long-term Outcomes for Living Pancreas Donors in the Modern Era. Transplantation. 2016 Jun;100(6):1322-8.
Expert comments for publication:
Although donor outcomes are generally good, living pancreas donation is associated with some donor morbidity including impaired glucose control. Donor morbidity can be minimized by using the authors risk stratification model and predonation counseling on life style modifications postdonation.