Preservation of the donor pancreas for whole pancreas and islet transplantation

Abstract

Whole pancreas and islet cell transplantation are both reliant upon the procurement and preservation of a high quality donor pancreas for a successful outcome. In the climate of a reducing donor pool it is imperative that donor optimization, meticulous surgical retrieval and evidence based methods of preservation are practiced to ensure optimal graft quality. Moreover expanded criteria donors and novel methods of pancreas preservation have the potential to expand the number of usable grafts and increase the availability of these transplant modalities to suitable patients with diabetes. This article provides a review of the current literature surrounding donor management, surgical technique and the various technologies of organ preservation applicable to the donor pancreas.

Augmented damage of islets by impaired exocrine acinar cells undergoing apoptosis that is possibly converted to necrosis during isolation

“…This acidosis kills cells by inducing lysosomal instability, activating enzymes, disrupting binding of transition ions to carrier proteins and altering mitochondrial properties. 12 Our results found that prolonged cold preservation affected exocrine acinar cells by little necrotic changes and abundant apoptotic proportions. On the other hand, islets viability inside the tissue was unaffected.…”

β-Cell regeneration: the pancreatic intrinsic faculty

“…Today, insulin-dependent patients rely on daily insulin injections. Transplantation of isolated islets from cadavers is problematic due to donor scarcity (about 6000 islets/kg of body weight are required [13][14][15]), and is only applicable to certain forms of diabetes; in addition, transplantation has met with limited success due to restricted engraftment survival [16][17][18][19]. A promising approach relies on devising unlimited in vitro generation of insulin- Table 1.…”

Islet Transplantation: Factors in Short-Term Islet Survival

“…The vast majority of islets for transplantation derive from donors who have been declared brain dead (Grundfest-Broniatowski and Novick 1986;Ridgway et al 2010;Shapiro et al 2000Shapiro et al , 2006. Jung et al (2007) have shown that islet yield from living donors is higher compared to cadaveric donors, and cerebrovascular stroke as cause of death and intracranial haemorrhage as mechanism of death are significantly associated with unsuccessful islet isolation (Takita et al 2010).…”

“…Conversely, outcomes are substantially worsened for nonheart beating donors (Jung et al 2007;Kenmochi et al 2008). Donors who have poor glucose control during their intensive care unit admission are less likely to provide a successful islet yield, as are those who require high levels of inotropes to attempt to maintain blood pressure (Brandhorst et al 1994(Brandhorst et al , 1995Lakey et al 1995;Ridgway et al 2010). …”

“…Conversely, overweight or obese donors give better islet yields (Brandhorst et al 1995;Ridgway et al 2010). Pancreata with fat on the surface, or fatty infiltration of the pancreas also give better islet yields (Kaddis et al 2010).…”