Pediatric donors in pancreas transplantation: challenges and opportunities.

Purpose of the review: The purpose of this review is to provide a comprehensive analysis of the current literature on pediatric donors for pancreas transplantation, with a focus on donor selection, clinical outcomes and surgical approaches. This review aims to highlight the feasibility and challenges of utilizing pediatric donors, assess the impact of donor and recipient selection criteria on outcomes, and explore innovations in surgical techniques.

Recent findings: Numerous retrospective studies show that pediatric donors yield outcomes comparable to those from adult donors. Despite challenges posed by small caliber vessels and donor-recipient size mismatches, favorable long-term outcomes, including high rates of insulin independence and stable graft function have been reported, even in cases where initial concerns about low islet mass existed. Complications such as thrombosis, pancreatitis, and ischemia-reperfusion injury remain risks, but improved anticoagulation protocols and perioperative management have significantly mitigated them. Surgical innovations, such as en-bloc transplantation with kidneys and refined vascular anastomosis techniques may minimize thrombotic and graft loss complications.

Summary: Pediatric donors are a viable option for pancreas transplantation, with outcomes matching those from adult donors, when properly selected and managed. Advances in surgical techniques and perioperative care have improved utilization and success rates.