{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,26]],"date-time":"2026-04-26T17:35:50Z","timestamp":1777224950834,"version":"3.51.4"},"reference-count":35,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100017245","name":"Hennepin Healthcare Research Institute","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100017245","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pancreas non\u2010utilization affects 25%\u201330% of deceased donor offers in the US. The European\u2010derived Pre\u2010Procurement Pancreas Suitability Score (P\u2010PASS) has performed inconsistently, is not validated in North America, and requires less accessible inputs, highlighting need for a robust prediction tool for non\u2010utilization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We developed a predictive model for pancreas non\u2010utilization using procured offers from the US SRTR (2003\u20132023). A multivariable logistic model used variables selected by causal diagram, LASSO, and univariable analyses. Model performance was evaluated using discrimination (AUC), calibration, and net reclassification improvement (NRI) versus a modified P\u2010PASS. Internal validation used 1000 bootstrap resamples. Sensitivity analyses included recent\u2010era offers, an all\u2010comer cohort including non\u2010procured offers, and excluding non\u2010donor\u2010related non\u2010utilizations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 30\u00a0757 pancreas offers, 26% were non\u2010utilized. The model incorporated ten factors: older age, male sex, higher BMI, hypertension, gastrointestinal disease, smoking, donation after cardiac death, stroke as cause of death, elevated terminal creatinine, and abnormal lipase. This model achieved moderate discrimination (AUC 0.699; optimism\u2010corrected 0.698), accurate calibration, Brier score 0.090, and 9.2% NRI. Sensitivity analyses confirmed robust performance, including AUC 0.8 among all\u2010comer offers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This model provides a practical, data\u2010driven tool that improves identification of high\u2010risk pancreata and may support more consistent, efficient utilization decisions. By demonstrating modifiable center\u2010level variation and outperforming P\u2010PASS in its first North American external validation, our findings offer a strong evidence base for targeted quality\u2010improvement and policy initiatives to enhance pancreas transplant activity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/ctr.70507","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T14:59:58Z","timestamp":1774969198000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Development of a Donor\u2010Based Predictive Model for Pancreas Non\u2010Utilization Among Deceased Donor Transplants in the US"],"prefix":"10.1111","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8040-7908","authenticated-orcid":false,"given":"Christie","family":"Rampersad","sequence":"first","affiliation":[{"name":"Ajmera Transplant Centre, Toronto General Hospital, University Health Network  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1148-113X","authenticated-orcid":false,"given":"Jason","family":"Bau","sequence":"additional","affiliation":[{"name":"School of Medicine Toronto Metropolitan University  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeffrey","family":"Schiff","sequence":"additional","affiliation":[{"name":"Ajmera Transplant Centre, Toronto General Hospital, University Health Network  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2303-1606","authenticated-orcid":false,"given":"Trevor","family":"Reichman","sequence":"additional","affiliation":[{"name":"Ajmera Transplant Centre, Toronto General Hospital, University Health Network  Toronto Ontario Canada"},{"name":"Department of Surgery University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5021-9831","authenticated-orcid":false,"given":"S. Joseph","family":"Kim","sequence":"additional","affiliation":[{"name":"Ajmera Transplant Centre, Toronto General Hospital, University Health Network  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1580"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-20999-4"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2013.138"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajt.2025.01.021"},{"key":"e_1_2_13_6_1","unstructured":"Organization WH.Diabetes.2024 (accessed March 10 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