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 histidinetryptophan-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.

Bone marrow increases human islets insulin positive cells in co-culture: quantification with flow cytometry

“…Existing protocols for maintaining human islets in vitro are limited, allowing only short-term (less than 72 h) storage of cells under conventional static culture conditions [5]. Extending the duration of culture beyond this period usually results in a significant loss of structural integrity within the islets and a decline in glucose-stimulated insulin release [6][7][8].…”

Advances in Machine Perfusion Graft Viability Assessment in Kidney, Liver, Pancreas, Lung, and Heart Transplant

“…[87][88][89] There were some early attempts in the 1970s to develop a protocol with MP and low perfusion pressures, but until recently, MP has been out of favor, as results from some early experiments favored cold storage, which was comparably straightforward. 90 Islet yields and quality have improved with the innovation of cold preservation techniques by the use of a 2-layer method that is now widely used in transplant centers, although it has been suggested that MP may further improve yields. 90 There are few recent studies involving ICT and MP for preservation, and even fewer with whole pancreas transplant.…”

Islet transplantation and antioxidant management: A comprehensive review

“…For the latest progress in these aspects of islet transplantation, readers are referred to two recently published review articles [8,9] .…”