Solid pancreas transplant outcomes with increased donor and recipient ages compared with reference ages: a systematic review

Background Increased recipient and donor age are associated with worse solid organ pancreas transplant outcomes. However, donor and recipient age criteria vary between jurisdictions. We systematically reviewed studies reporting the association between transplanting older recipients and donors beyond current Transplantation Society of Australia and New Zealand (TSANZ) limits with solid pancreas transplant outcomes. Aims To review current outcomes of solid pancreas transplantation in recipients and donors over the TSANZ reference ages. Methods Studies comparing transplant outcomes between a reference‐age and an older‐age donor (>45 years) or recipient (≥50 years) cohort for solid pancreas transplantation were included. Primary outcomes were pancreas/kidney graft and patient survival at 1 and 5 years. Secondary outcomes were post‐transplant complications (graft thrombosis, acute rejection and relaparotomy rates). Results Eleven studies were included (two studies assessing solid pancreas outcomes between older vs reference‐aged donors and nine studies assessing outcomes between older vs reference‐aged recipients). Seven of 11 studies were judged to be at high risk of bias. Primary and secondary outcomes were not significantly different between recipient age groups in nine studies. A sensitivity analysis of older versus reference‐aged studies excluding studies at high risk of bias also showed non‐inferior primary and secondary outcomes at 1 year. Two studies comparing outcomes by donor age showed worse graft survival but non‐inferior patient survival with older donors. Conclusion Increased donor or recipient age alone should not absolutely contraindicate solid pancreas transplantation, especially if other risk predictors are minimised.