SRTR Pancreas Graft Risk (Axelrod et al.)
Pancreas Donor Factors
years
kg/m²
cm
mg/dL
hours
Total preservation time
PDRI
Assess pancreas donor risk for graft survival prediction.
Guidelines & Evidence
Verified
Last Review: 2026-07-17
When to Use
When to Use
To assess the risk of pancreas graft failure at the time of donor offer
To guide organ acceptance decisions for pancreas and SPK transplantation
To stratify donor quality for recipient matching
To counsel recipients about expected graft survival
To support research on pancreas transplant outcomes
Interpretation
The PDRI is a ratio where 1.0 represents the average deceased pancreas donor in the United States. Higher values indicate increased risk of graft failure (primarily from graft thrombosis and early graft loss). PDRI > 1.5 is generally considered elevated risk.
How it Works
PDRI Components (Axelrod et al.)
01
Donor Age: The dominant predictor. Risk increases significantly after age 40.
02
BMI: Donor BMI > 30 is associated with increased technical failure from steatosis and graft pancreatitis.
03
Cause of Death: CVA/stroke donors carry higher risk than head trauma or anoxia.
04
DCD Donation: DCD pancreas donors are at substantially increased risk of graft thrombosis.
05
Donor Creatinine: Elevated creatinine may reflect systemic donor factors affecting organ quality.
06
Cold Preservation Time: Preservation > 12 hours increases risk of graft pancreatitis and thrombosis.
07
Donor Height: Height < 160 cm is associated with smaller pancreatic mass and potentially increased technical risk.
Clinical Pearls
PDRI in Clinical Practice
The PDRI is most useful when comparing multiple simultaneous organ offers or deciding whether to proceed with a lower-quality donor. Unlike SPK recipients who may return to dialysis if the pancreas fails, pancreas-alone recipients face risk of diabetes recurrence without a fallback. High PDRI donors should be considered primarily for SPK candidates who would benefit from the kidney component even if the pancreas fails early.
Limitations
PDRI does not capture donor pancreas quality beyond donor demographics (no steatosis assessment, no C-peptide)
The model was derived from US data (2000-2006) — contemporary outcomes with newer immunosuppression may differ
Centre experience is a major unmeasured factor — high-volume centres have better outcomes with high-PDRI donors
PDRI predicts graft loss, not patient survival — SPK candidates may still derive survival benefit from the kidney component
Next Steps
Guiding Acceptance
01
PDRI < 1.0: Standard risk. Acceptable for most candidates.
02
PDRI 1.0-1.5: Moderate risk. Acceptable for SPK or appropriately selected PAK candidates.
03
PDRI 1.5-2.0: High risk. Consider for SPK candidates who are highly sensitised or have long anticipated wait times.
04
PDRI > 2.0: Very high risk. Caution. May be appropriate only in exceptional circumstances.
The Evidence
Original Derivation
Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization.
Axelrod DA et al. • Am J Transplant.. 2010;10(4):837–845. n = 5,729 pancreas transplant recipients. C-statistic 0.64 for graft survival.
View SourceOrigins & History
Development
The PDRI was developed by Dr. David Axelrod and colleagues using SRTR data, following the methodology established by the KDRI for kidneys and DRI for livers. The development of pancreas-specific risk indices was driven by the recognition that pancreas grafts are exceptionally vulnerable to donor factors, with graft thrombosis rates far exceeding those of other solid organs.
Last Comprehensive Review: 2026-07-17