TOWARD IMPROVED SURGICAL TECHNIQUES FOR PIG PANCREAS PROCUREMENT

Abstract

Background: Warm ischemia time (WIT) and elevated temperature during pancreas procurement can significantly affect the viability of transplanted tissue. Quantitative information on these parameters is currently lacking and needed. Aim: To evaluate and optimize the efficiency, effectiveness, and practicality of existing and emergent pancreas procurement techniques in non-heart beating donor pigs by measuring the WIT and the organ temperature in situ. Methods: Pancreata were removed by en bloc viscerectomy from 81 female Landrace pigs. The first procurement method (27%) utilized only crushed ice for cooling. The second method (25%) utilized crushed ice and a vascular flush of cold preservation solution by cannulation of the suprarenal aorta. A third method (48%) was developed to selectively flush through the celiac trunk (CT) and the superior mesenteric artery (SMA). Ductal infusion with preservation solution was also investigated in conjunction with all three methods. Temperature measurements were taken by needle probe in several organs. Results: Vascular flush (methods 2 and 3) resulted in improved cooling and macroscopic pancreas morphology compared to surface cooling (method 1) which can take >30 min to cool the core to 4 °C. Method 3 eliminates solution waste without increasing WIT. Ductal infusion improved organ cooling but was not as effective as the vascular flush. Conclusions: Selective CT and SMA flush with cold storage solution in conjunction with ductal infusion promotes rapid cooling and improves pancreas preservation.