Toggle Main Menu Toggle Search

Open Access padlockePrints

The impact of time to death in donors after circulatory death on recipient outcome in simultaneous pancreas-kidney transplantation

Lookup NU author(s): Abdullah Malik, Dr Sam Tingle, Dr Balaji Mahendran, Professor Derek Manas, Professor Colin Wilson, Steven White



This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).


© 2024 The AuthorsThe time to arrest donors after circulatory death is unpredictable and can vary. This leads to variable periods of warm ischemic damage prior to pancreas transplantation. There is little evidence supporting procurement team stand-down times based on donor time to death (TTD). We examined what impact TTD had on pancreas graft outcomes following donors after circulatory death (DCD) simultaneous pancreas-kidney transplantation. Data were extracted from the UK transplant registry from 2014 to 2022. Predictors of graft loss were evaluated using a Cox proportional hazards model. Adjusted restricted cubic spline models were generated to further delineate the relationship between TTD and outcome. Three-hundred-and-seventy-five DCD simultaneous kidney-pancreas transplant recipients were included. Increasing TTD was not associated with graft survival (adjusted hazard ratio HR 0.98, 95% confidence interval 0.68-1.41, P = .901). Increasing asystolic time worsened graft survival (adjusted hazard ratio 2.51, 95% confidence interval 1.16-5.43, P = .020). Restricted cubic spline modeling revealed a nonlinear relationship between asystolic time and graft survival and no relationship between TTD and graft survival. We found no evidence that TTD impacts pancreas graft survival after DCD simultaneous pancreas-kidney transplantation; however, increasing asystolic time was a significant predictor of graft loss. Procurement teams should attempt to minimize asystolic time to optimize pancreas graft survival rather than focus on the duration of TTD.

Publication metadata

Author(s): Malik AK, Tingle SJ, Chung N, Owen R, Mahendran B, Counter C, Sinha S, Muthasamy A, Sutherland A, Casey J, Drage M, van Dellen D, Callaghan CJ, Elker D, Manas DM, Pettigrew GJ, Wilson CH, White SA, NHSBT Pancreas Advisory Group

Publication type: Article

Publication status: Published

Journal: American Journal of Transplantation

Year: 2024

Pages: epub ahead of print

Online publication date: 14/02/2024

Acceptance date: 07/02/2024

Date deposited: 18/03/2024

ISSN (print): 1600-6135

ISSN (electronic): 1600-6143

Publisher: Elsevier B.V.


DOI: 10.1016/j.ajt.2024.02.008

PubMed id: 38360185


Altmetrics provided by Altmetric


Funder referenceFunder name
National Institute of Health and Care Research (NIHR)