Preserving and perfusing the allograft pancreas: Past, present, and future

Area of Science:

• Transplantation immunology
• Organ preservation science
• Surgical innovation

Background:

• Organ preservation by perfusion has a long history, with significant advancements in temperature regulation, perfusion fluid composition, and pumping systems.
• Machine preservation techniques have successfully improved graft utilization, viability assessment, and survival rates for liver, heart, and kidney transplants.
• Despite the critical need, pancreas transplantation has not benefited equally from perfusion technology advancements.

Observation:

• Current pancreas preservation methods include static cold storage, specialized preservation solutions, and the 'two-layer method'.
• Machine perfusion is an emerging technology with potential for pancreas preservation.
• Understanding of ischemia-reperfusion injury and advancements in machine preservation offer new avenues for improvement.

Findings:

• A review of literature up to December 2017 reveals diverse pancreas preservation techniques.
• Static cold storage remains a primary method, but its limitations are apparent compared to machine perfusion in other organs.
• Machine perfusion systems are being explored for their potential to enhance pancreas graft quality.

Implications:

• Improved pancreas preservation techniques, particularly machine perfusion, could significantly increase graft utilization and patient survival.
• Further research and development in pancreas-specific perfusion are essential to match the success seen in other solid organ transplants.
• Addressing ischemia-reperfusion injury through advanced preservation strategies holds promise for better transplant outcomes.