NIV Congres

Introduction Because of the shortage of donor pancreas for pancreatic islet transplantation we aim to enlarge the donor pool by using extended criteria donors. Organs from these donors are associated with high susceptibility to hypoxic damage. Optimization of organ preservation methods may ameliorate hypoxic damage. The traditional cold storage (CS) method of pancreas preservation lead to hypoxia of the pancreatic tissue. It is hypothesized that oxygenated hypothermic machine perfusion (HMP) of the pancreas results in less hypoxia, less hypoxic damage resulting in a better quality of the isolated pancreatic islets.

Methods In a pilot study 5 extended criteria human donor pancreas were procured and transported using HTK/UW CS (8.3 +/- 3.10 hrs CIT). The pancreases were splitted transversally at the neck, resulting in a head and tail section. From each organ, one section was preserved on ice (CS). The other section was subjected to 3 hours arterio-venous HMP (UW-MP, 100% pO2, 20mmHg). After prolonged CS and HMP islets were isolated separately. Pair wise, HMP (2 head, 3 tail) sections were compared with the CS (3 head, 2 tail) sections on organ physiology (edema, oxygenation, amylase, lipase, LDH), isolation parameters (tissue retrieval, gene expression, ATP content, islet yield and islet purity) and islet quality (gene expression, islet survival, induction ratio) parameters.

Results No significant changes were observed in islet yield, islet survival or islet function. In the HMP perfusate increasing concentrations of amylase, lipase and LDH were detected, in line with the expected wash-out. Interstitial pO2 increased strongly from non-detectable levels to 80-90% pO2. In general, mRNA expression was elevated in HMP tissue as compared to CS. The change in tissue ATP content after three hours HMP increased significantly.

Conclusion Three hours of oxygenated machine perfusion of the pancreas does not increase islet yield, function or viability. However, it does lead to a better oxygenation status of the tissue, as implied by the increased pO2, mRNA levels and ATP content in the pancreatic tissue. We hypothesize that increasing duration of HMP will translate augmented organ parameters to better islet preparations.