Abstract
Purpose of ReviewPancreas 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 FindingsHypothermic 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 refinement—focusing on perfusion protocols and viability assessment tools.SummaryEmerging 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.
Highlights
Current State of Pancreas TransplantationDiabetes mellitus is one of the fastest growing chronic diseases in the world with an estimated 422 million people, or 8.5% of the world’s population, suffering from diabetes in 2014 [1]
The Diabetes Control and Complications Trial (DCCT) [5] showed tight blood glucose control depicted by target glycated haemoglobin (HbA1C) levels of less than 7% in participants with type 1 diabetes lowered the incidence of diabetic retinopathic, neuropathic, and nephropathic lesions by 47%, 60%, and 39% respectively
In the UK, the poor rate of conversion from potential donors to a transplant has been associated with concerns regarding donor history, high rates of pancreatic retrieval injury, anxiety over the visual appearance of the retrieved graft related to fat content [26], and the perception that donation after cardiac death (DCD) and extended criteria donors (ECD) donor pancreata are at higher risk of delayed graft function (DGF) and surgical complications
Summary
Diabetes mellitus is one of the fastest growing chronic diseases in the world with an estimated 422 million people, or 8.5% of the world’s population, suffering from diabetes in 2014 [1]. In the UK, there are 4.7 million persons with diabetes and a further 1.1 million people who have diabetes and remain undiagnosed. 10% of people with diabetes have type 1 diabetes [2]. This article is part of the Topical Collection on Immunology, Transplantation, and Regenerative Medicine. Pancreas transplantation is not an immediate lifesaving procedure; as such in the majority of cases, it is jointly undertaken in patients with diabetes who require renal
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