Living Donor Work-Up

Although the principles for evaluating a potential pancreas donor are not different than for other solid-organ transplants, living donors of a pancreas segment must undergo thorough metabolic testing pre-donation to minimize the risk of developing diabetes post-donation. Metabolic testing and selection criteria have evolved over time. Due to the use of strict metabolic criteria, only about 15-20% of all potential pancreas donors qualify. While the majority of living donors tolerate a hemipancreatectomy without negative metabolic consequences, at least one-third of donors demonstrate metabolic changes long term. About one-fourth of all donors will eventually require oral hypoglycemic medications or even insulin. Over the past three decades, strict exclusion criteria have been developed and helped to reduce the rate of post-donation diabetes. A risk stratification model showed that certain parameters are associated with the development of post-donation diabetes: specifically, three pre-donation risk factors (oral glucose tolerance test, basal insulin, fasting plasma glucose) and one post-donation modifiable risk factor (BMI) were identified. It was further shown that the presence of two or more risk factors was associated with a 100% rate of becoming diabetic post-donation whereas, in the absence of these risk factors, none of the donors became diabetic. Of note, the recipient graft failure rate is higher for the recipients whose donors went on to become diabetic: 75% versus 39% for non-diabetic donors (p ≤ 0.05). The reason(s) for this somewhat surprising finding is speculative, but a specific molecular or immunologic predisposition to the (long-term) development of diabetes in these pancreases cannot be ruled out and warrants further investigation. Detailed counseling pre-donation about potential lifestyle adjustments after donation including avoidance of weight gain is important to minimize the risk of post-donation diabetes. Pancreas transplantation from a living donor can be performed with excellent outcomes, specifically if donor morbidity can be minimized by adhering to pre-donation selection criteria and using a specific risk stratification model.