Pancreas preservation for pancreas and islet transplantation

Abstract

Purpose of review To summarize advances and limitations in pancreas procurement and preservation for pancreas and islet transplantation, and review advances in islet protection and preservation. Recent findings Pancreases procured after cardiac death, with in-situ regional organ cooling, have been successfully used for islet transplantation. Colloid-free Celsior and histidine-tryptophan-ketoglutarate preservation solutions are comparable to University of Wisconsin solution when used for cold storage before pancreas transplantation. Colloid-free preservation solutions are inferior to University of Wisconsin solution for pancreas preservation prior to islet isolation and transplantation. Clinical reports on pancreas and islet transplants suggest that the two-layer method may not offer significant benefits over cold storage with the University of Wisconsin solution: improved oxygenation may depend on the graft size; benefits in experimental models may not translate to human organs. Improvements in islet yield and quality occurred from pancreases treated with inhibitors of stress-induced apoptosis during procurement, storage, isolation or culture. Pancreas perfusion may be desirable before islet isolation and transplantation and may improve islet yields and quality. Methods for real-time, noninvasive assessment of pancreas quality during preservation have been implemented and objective islet potency assays have been developed and validated. These innovations should contribute to objective evaluation and establishment of improved pancreas preservation and islet isolation strategies. Summary Cold storage may be adequate for preservation before pancreas transplants, but insufficient when pancreases are processed for islets or when expanded donors are used. Supplementation of cold storage solutions with cytoprotective agents and perfusion may improve pancreas and islet transplant outcomes.

Flow distribution during infusion of UW and HTK solution in anaesthetised rats

“…UW solution was initially developed for pancreas preservation [31], but was subsequently shown to be excellent also for other abdominal organs [5] as well as islets [11]. Similarly, also celsior and HTK solution have proven valuable in this context [13]. However, despite recent modifications and improvements in islet isolation techniques, it is still often possible to isolate only 50-70% of the total number of islets from a human pancreas [14,15].…”

“…At present, UW solution is the most widely used since it can be applied to all abdominal organs and also, to some extent, for hearts and lungs [1][2][3]5]. Also, HTK solution, initially used for heart preservation with its low potassium content, has proven effective in abdominal transplantations [13]. .…”

“…UW solution is at present one of the preservation media of choice for transplantation of abdominal organs [1,5] and has also been shown to be effective in preserving the function of pancreatic islets after isolation and transplantation [11,12]. However, recently also other preservation solutions such as HTK solution [8] and colloid-free celsior solution have proven to be adequate for this purpose [13]. However, despite recent modifications and improvements in islet isolation techniques, it is still often possible to isolate only 50-70% of the total number of islets in a human pancreas [14,15].…”

Perfluorocarbon Improves Post-Transplant Survival and Early Kidney Function following Prolonged Cold Ischemia

“…Consequently, the TLM was reported to achieve better organ function in experimental pancreas [5,6] , heart [7] and intestinal transplantation [8] and to rescue the graft in a model of prolonged warm ischemia time [9] . Higher pancreatic islet yield and better function has been found by several research groups in comparison with conventional UW pancreas storage in experimental [10][11][12] , as well as in clinical studies [13,14] , though this effect has not been confirmed in a larger series [15][16][17] . The TLM for pancreas transplantation has therefore become a standard procedure in several centers supposedly enabling to prolong the cold ischemia time before islet isolation [18][19][20][21] .…”

Teucrium polium Complex with Molybdate Enhance Cultured Islets Secretory Function

“…During isolation, islets are endangered of mechanical and hypoxic injury which results in excessive oxidative stress and low viability and function. Therefore, methods that can improve islets resistance to oxidative stress are needed to investigate in researches [1][2][3]. Various antioxidant agents like vitamin supplements, herbs, trace elements, and drugs as well as anti-inflammatory drugs have been widely used in different studies to improve function of isolated islets before or after the transplantation [4,5].…”