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Pancreas preservation for pancreas and islet transplantation

Iwanaga, Yasuhiroa,b; Sutherland, David ERb; Harmon, James Vb; Papas, Klearchos Kb

Current Opinion in Organ Transplantation: April 2008 - Volume 13 - Issue 2 - p 135–141
doi: 10.1097/MOT.0b013e3282f63942
Organ preservation and procurement: Edited by Luis H. Toledo-Pereyra
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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 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 desirable before islet isolation and transplantation and may improve islet yield 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.

aTransplantation Unit, Kyoto University Hospital, Kyoto, Japan

bDepartment of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, USA

Correspondence to David E.R. Sutherland, MD, PhD, Department of Surgery, University of Minnesota, MMC 280, 420 Delaware Street SE, Minneapolis, MN 55455, USA Tel: +1 612 625 7600; e-mail: dsuther@umn.edu

© 2008 Lippincott Williams & Wilkins, Inc.