Impact of adverse pancreatic injury at surgical procurement upon islet isolation outcome

Andrès, Axel; Kin, Tatsuya; O’Gorman, Doug; Bigam, David L.; Kneteman, Norman M.; Senior, Peter; Shapiro, AM James

doi:10.1111/tri.12392

Cited by 12 publications

(7 citation statements)

References 18 publications

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“…Fernandez et al examined 27 procured pancreata; 3 of 18 pancreata had vascular damage (15). The largest analysis of pancreas injuries was performed on 452 organs procured for islet transplantation (18). Parenchymal injuries were identified in 42 pancreata (9.3%), with damage to the main pancreatic duct in 15 organs (3.3%).…”

Section: Discussionmentioning

confidence: 99%

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

Ausania

Drage

Manas

et al. 2015

American Journal of Transplantation

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Surgical injury to the pancreas is thought to occur commonly during procurement. The UK Transplant Registry was analyzed to determine the frequency of pancreatic injuries, identify factors associated with damage, and assess the impact of injuries on graft survival. Twelve hundred ninety-six pancreata were procured from donation after brain death donors, with 314 (19.5%) from donation after circulatory death donors. More than 50% of recovered pancreata had at least one injury, most commonly a short portal vein (21.5%). Liver donation, procurement team origin, hepatic artery (HA) arising from the superior mesenteric artery (SMA), and increasing donor BMI were associated with increased rates of pancreas damage on univariate analyses; on multivariate analysis only the presence of an HA from the SMA remained significant (p ¼ 0.02). Six hundred forty solid organ pancreas transplants were performed; 238 had some form of damage. Overall, there was no difference in graft survival between damaged and undamaged organs (p ¼ 0.28); however, graft loss was significantly more frequent in pancreata with arterial damage (p ¼ 0.04) and in those with parenchymal damage (p ¼ 0.05). Damage to the pancreas during organ recovery is more common than other organs, and meticulous surgical technique and awareness of damage risk factors are essential to reduce rates of procurement-related injuries.

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Section: Discussionmentioning

confidence: 99%

A Registry Analysis of Damage to the Deceased Donor Pancreas During Procurement

Ausania

Drage

Manas

et al. 2015

American Journal of Transplantation

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“…Current American Society of Transplant Surgeons guidelines still recommend that the pancreatic head should be routinely transected if the pancreas is not used to avoid an injury of a right replaced hepatic artery, its identification being potentially more challenging in a cold and pulseless field . If the pancreas is transected, this significantly reduces the ability of the islet isolation team to isolate sufficient islets for transplantation . We now advocate that hepatic dissection should routinely maintain the pancreas intact, where there are plans for subsequent islet isolation.…”

Section: Discussionmentioning

confidence: 99%

Clinical islet isolation and transplantation outcomes with deceased cardiac death donors are similar to neurological determination of death donors

et al. 2015

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SummaryIn islet transplantation, deceased cardiac death (DCD) donation has been identified as a potential extended source. There are currently no studies comparing outcomes between these categories, and our goal was to compare islet isolation success rates and transplantation outcomes between DCD and neurological determination of death (NDD) donors. Islet isolations from 15 DCD and 418 NDD were performed in our centre between September 2008 and September 2014. Donor variables, islet yields, metabolic function of isolated isled and insulin requirements at 1-month post-transplant were compared. Compared to NDD, pancreata from DCD were more often procured locally and donors required less vasopressive support (P < 0.001 and P = 0.023, respectively), but the other variables were similar between groups. Pre-and postpurification islet yields were similar between NDD and DCD (576 vs. 608 9 10 3 islet equivalent, P = 0.628 and 386 vs. 379, P = 0.881, respectively). The metabolic function was similar between NDD and DCD, as well as the mean decrease in insulin requirement at 1-month post-transplantation (NDD: 64.82%; DCD: 60.17% reduction, P = 0.517). These results support the broader use of DCD pancreata for islet isolation. A much larger DCD islet experience will be required to truly determine noninferiority of both short-and long-term outcomes.

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“…Indeed, several studies have demonstrated that a dedicated surgical team currently is the most important determinant for the clinical outcome of islet allotransplantation. 67 Second, research into the optimal approach to pancreas preservation, whether persufflation, normothermic perfusion, or perfluorocarbon incubation 68 - 70 is vital (see previous section on whole organ transplantation). Finally, the stringent regulation associated with human islet isolation described above, means that islet isolation/islet transplant networks will increasingly become the norm.…”

Section: Islet Allotransplantationmentioning

confidence: 99%