NIV Congres

Introduction In the field of clinical islet transplantation certain donor risk factors, such as BMI, have been shown to have impact on islet yield. For vascularized pancreas transplantation risk models have been proposed (PDRI, P-PASS), but are not validated in contrast to certain liver donor risk indices (DRI, ET-DRI).

Objective Identification of donor and transplant risk factors that affect islet yield after pancreatic islet isolation.

Methods All consecutive pancreatic islet isolations performed at the LUMC from January 2008 till October 2012 were analyzed. P-PASS, PDRI, DRI, ET-DRI, donor and transplant factors were analyzed with multivariate models to identify risk factors that affect islet yield.

Results In total 195 isolations were performed. Donor and transplant factors were (median): age 53 years, female 50%, BMI 25, COD (CVA 64%, trauma 18%), DCDD 29%, cardiac arrest 29%, history of alcohol abuse 10%, hypertension 22%, smoking 56%, lipase 22U/L, amylase 103U/L, HbA1c 5.5%, creatinin 65µmol/L, cold ischemia time (CIT) 8.7h, perfusion fluid (UW 61%, HTK 33%), P-PASS 18 and PDRI 1.82. Median islet yield was 435.000 IEQ and 3872 IEQ/gram. P-PASS and PDRI did not correlate with IEQ (PDRI p=0.74 and ‘reversed’ P-PASS p<0.001) nor IEQ/gram (PDRI p=0.24 and reversed P-PASS p<0.001). Interestingly (liver) DRI and ET-DRI were significant for IEQ and IEQ/gram (DRI p=0.025 and p=0.013; ET-DRI p=0.039 and p=0.005). After multivariate analysis of donor and transplant factors, BMI (p<0.001), latest bilirubin (p=0.015) and CIT (p=0.009) were significantly associated with islet yield. Multivariate analysis of DRI and ET-DRI showed significance for both models (resp. p<0.001 and p=0.019).

Conlcusion Analysis of donor factors showed that donor BMI, bilirubin and CIT have a significant impact on islet yield after pancreatic islet isolation. Two risk models for whole pancreas transplantation (P-PASS, PDRI) did not significantly correlate with islet yield, interestingly the (liver) DRI and ET-DRI did.