Normothermic Perfusion of Discarded Human Pancreases.

Abstract

Introduction: Pancreas transplantation (solid organ or islets) is the most effective treatment for patients with progressive complications of diabetes, or patients with labile blood sugar control and hypoglycaemia unawareness. Increasing demand for transplants requires the use of more marginal donor organs, including those from DCD donors. However, the deleterious effects of cold ischaemia affect the viability of the organ and are exacerbated by prior injury. Currently there is no validated means to test the viability of the organ before transplantation. There is accumulating evidence of the benefits of a more physiological approach using continuous perfusion of an oxygenated, blood-based perfusate at normal body temperature. We describe here the practicality of normothermic ex-vivo perfusion of human pancreases. Methods: Human pancreases that were turned down by all transplant units have been utilised. A cardiopulmonary circuit consisting of oxygenator, heat exchanger, centrifugal pump, reservoir, flow probes and gate clamp is primed with research red cells and the temperature maintained at 38°C. The circuit is primed with antibiotics and heparin. A continuous infusion of heparin, prostacyclin and bicarbonate is provided. The arterial inflow of the pancreas is cannulated and venous outflow collected and recirculated. Effluent from the duodenal segment is collected and measured. Results: Using this circuit, it is possible to achieve stable normal arterial pressures and flows. During preservation, physiological flows and pressures are maintained in the splenic artery and the superior mesenteric artery by controlling the pump head speed and adjusting the proportional pinch valve on the bypass circuit. Serum amylase drops over the length of the perfusion whilst duodenal amylase production increases. Total protein levels gradually decrease suggesting a functioning organ. Discussion: This is the first demonstration of successful normothermic perfusion of the human pancreas. This has the potential to increase the viability, assessment and safety of donor organs in this expanding field. DISCLOSURES:Ravikumar, R.: Other, OrganOx, Consultant. Coussios, C.: Other, OrganOx, Technical Director. Friend, P.: Other, OrganOx, Medical Director.