Use of Ex Vivo Normothermic Perfusion for Quality Assessment of Discarded Human Donor Pancreases

Abstract

A significant number of pancreases procured for transplantation are deemed unsuitable due to concerns about graft quality and the associated risk of complications. However, this decision is subjective and some declined grafts may be suitable for transplantation. Ex vivo normothermic perfusion (EVNP) prior to transplantation may allow a more objective assessment of graft quality and reduce discard rates. We report ex vivo normothermic perfusion of human pancreases procured but declined for transplantation, with ABO‐compatible warm oxygenated packed red blood cells for 1–2 h. Five declined human pancreases were assessed using this technique after a median cold ischemia time of 13 h 19 min. One pancreas, with cold ischemia over 30 h, did not appear viable and was excluded. In the remaining pancreases, blood flow and pH were maintained throughout perfusion. Insulin secretion was observed in all four pancreases, but was lowest in an older donation after cardiac death pancreas. Amylase levels were highest in a gland with significant fat infiltration. This is the first study to assess the perfusion, injury, as measured by amylase, and exocrine function of human pancreases using EVNP and demonstrates the feasibility of the approach, although further refinements are required.

Short, Cool, and Well Oxygenated – HOPE for Kidney Transplantation in a Rodent Model

“…In summary, although normothermic oxygenated perfusion is superior to evaluate online organ metabolism, 35 it also triggers reperfusion injury ex vivo, depending on the extent of donor ischemia. In contrast, HOPE prevents oxidative stress during implantation, possibly by mitochondrial repair mechanism.…”

The future of organ perfusion and re‐conditioning

“… demonstrated the feasibility of ex situ pancreas NMP in which they could correlate amylase levels with fat infiltration of the organ and exocrine function. However, this approach needs more refinement and is not yet ready for clinical application . For future research and clinical progression, it may be important to invest in the normothermic preservation technology as has been done in liver and kidney transplantation.…”

Opportunities for Therapeutic Intervention During Machine Perfusion

“…As the donor population ages and the prevalence of obesity and diabetes increases, donor organ quality is likely to further decrease in the coming years[1]. Thus, machine perfusion (MP) has attracted increasing attention, over the past decade, as an alternative or adjuvant to conventional static cold storage (SCS), both to provide superior preservation [2] and to provide data to more accurately evaluate marginal organs [3–6]. This paper will briefly review the preservation and diagnostic advantages of MP, but will focus on the potential for actually improving organ quality after procurement (summarized in table 1).…”

“…In an experimental study on NMP of porcine DCD hearts, one group found that stroke work, ejection fraction and minimum rate of diastolic pressure change were more reliable predictors of organ viability and function than coronary vascular resistance (CVR), myocardial oxygen consumption (MVO 2 ) and venoarterial lactate difference [25]. Barlow et al were the first to show the feasibility of ex-situ NMP to assess the viability and function of declined human pancreas for transplantation based on pancreas blood flow, exocrine function indicated by insulin secretion and endocrine function indicated by lipase and amylase secretion [6]. …”