Machine Perfusion and the Pancreas: Will It Increase the Donor Pool?

Abstract

Purpose of Review Pancreas transplantation enables complete patient independence from exogenous insulin administration and increases both patient survival and quality of life. Despite this, there has been a decline in pancreas transplantation for the past 20 years, influenced by changing donor demographics with more high-risk extended criteria (ECD) and donation after cardiac death (DCD) donors. This review discusses whether the advent of machine perfusion (MP), if extended to the pancreas, can increase the pool of suitable donor organs. Recent Findings Hypothermic and normothermic MP, as forms of preservation deemed superior to cold storage for high-risk kidney and liver donor organs, have opened the avenue for translation of this work into the pancreas. Recent experimental models of porcine and human ex-vivo pancreatic MP are promising. Applications of MP to the pancreas however need refinementfocusing on perfusion protocols and viability assessment tools. Summary Emerging research shows pancreatic MP can potentially offer superior preservation capacity, the ability to both resuscitate and manipulate organs, and assess functional and metabolic organ viability. The future of MP will lie in organ assessment and resuscitation after retrieval, where ultimately organs initially considered high risk and unsuitable for transplantation will be optimised and transformed, making them then available for clinical use, thus increasing the pool of suitably viable pancreata for transplantation.

Organ Restoration With Normothermic Machine Perfusion and Immune Reaction

“…There are similar studies of hypothermic machine perfusion of the pancreases, that demonstrated reduced graft oedema and reduced islet and acinar damage (19,20). One study using 20 human pancreases in a hypothermic pulsatile perfusion of marginal human pancreas-duodenum organs for 24 h showed that this strategy was feasible with no deleterious parenchymal effect (21).…”

The Effect of Preservation Temperature on Liver, Kidney, and Pancreas Tissue ATP in Animal and Preclinical Human Models

“…Existing challenges include the lack of recognised viability markers, and technical obstacles like susceptibility of vascular endothelial lining to MP flow. ATP generation as a means to evaluate cellular metabolism and as part of the functional assessment of the organ were once again highlighted [58]. The characteristics of two studies on HMP and NMP that reported tissue ATP as one of the primary endpoints are shown in Tables 8 and 9, respectively.…”

Back-table surgery pancreas allograft for transplantation: Implications in complications

“…To address this problem, it is necessary to define which preservation protocol is the best for the pancreas (hypo, normo or subnormothermia) and, especially, how the viability and functionality of the graft can be tested. This last aspect is important, if we consider the percentage of grafts discarded due to their fat content or due to edema of the gland[ 11 ].…”