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Islet vs. pancreas transplantation in Brazil: Defining criteria for pancreas allocation decision

机译：巴西的胰岛和胰腺移植：定义胰腺分配决定标准

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Background: Many studies have evaluated whether there are characteristics related to pancreas donors and the islet isolation process that can influence pancreatic islet yield. However, this analysis has not yet been performed in Brazil, one of the world leaders in whole pancreas organ transplantation (WOPT), where pancreas allocation for pancreatic islet transplantation (PIT) has no officially defined criteria. Definition of parameters that would predict the outcome of islet isolation from local pancreas donors would be useful for defining allocation priority in Brazil. Objective: To analyze the relationship between multiple donor-related and islet isolation variables with the total number of isolated pancreatic islet equivalents (IEQ) in a Brazilian sample of pancreas donors. Methods: Several variables were analyzed in 74 pancreata relative to the outcome of total IEQs obtained at the end of the process. Results: In univariate analysis, body mass index (BMI) (p = 0.003), the presence of fatty infiltrates in the pancreas as observed during harvesting (p = 0.042) and pancreas digestion time (p = 0.046) were identified as variables related to a greater IEQ yield. In a multivariate analysis a statistically significant contribution to the variability of islet yield was found only for the BMI (p = 0.017). A ROC curve defined a BMI = 30 as a cut-off point, with pancreata from donors with BMI > 30 yielding more islets than donors with BMI < 30 (p < 0.001). Conclusion: These data reinforce the importance of the donor BMI as a defining parameter for successful islet isolation and establishes this variable as a potential pancreas allocation criterion in Brazil, where there is unequal competition for good quality organs between WOPT and PIT.
机译：背景：许多研究已经评估了是否存在与胰腺供体和胰岛分离过程相关的特征，这些特征会影响胰岛的产量。但是，在整个胰脏器官移植（WOPT）的世界领导者之一巴西，尚未进行此分析，在巴西，胰腺胰岛移植（PIT）的胰腺分配没有正式定义的标准。定义可预测胰岛与当地胰腺捐赠者隔离的结果的参数的定义对于定义巴西的分配优先级将很有用。目的：分析巴西胰腺供体样本中多个供体相关和胰岛分离变量与胰岛当量（IEQ）总数之间的关系。方法：相对于该过程结束时获得的总IEQ，分析了74个胰腺中的几个变量。结果：在单变量分析中，将体重指数（pMI）（p = 0.003），收获期间观察到的胰腺中脂肪浸润的存在（p = 0.042）和胰腺消化时间（p = 0.046）确定为与以下因素相关的变量更高的IEQ产量。在多变量分析中，仅对于BMI，发现对胰岛产量变异性有统计学意义的贡献（p = 0.017）。 ROC曲线将BMI = 30作为临界点，来自BMI> 30的供体的胰岛比BMI <30的供体产生的胰岛更多（p <0.001）。结论：这些数据加强了供体BMI作为成功分离胰岛的定义参数的重要性，并将该变量确立为巴西潜在的胰腺分配标准，在巴西，WOPT和PIT之间对优质器官的竞争不平等。

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