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Breaking the limits of experimental pancreas transplantation: Working toward the clinical ideal graft
Joana Ferrer-Fàbrega1,2,3, Emma Folch-Puy2,4, Andrea Llaves-López4
1Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Clinic Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic, University of Barcelona, Barcelona, Spain.
Abstract:
Pancreas transplantation is, at present, the only curative treatment for type-1 diabetes that maintains normoglycemia thus avoiding complications arising from poor glycemic control. Despite its great benefits, the number of pancreas transplants has decreased significantly since its inception in the late 1960s, largely due to demographic changes and the consequent suboptimal quality of donors. The selection criteria for pancreas donors mainly depend on morphological variables such as fatty infiltration, fibrosis, or edema, as well as both functional (amylase and lipase) and clinical variables of the donor. However, the final criterion in the decision-making process is the somewhat subjective assessment of a trained surgeon. That being said, the recent incorporation of graft perfusion machines into clinical practice seems to be changing the work dynamics of the donor organ retrieval team, facilitating decision-making based on objective morphological and functional criteria. Normothermic perfusion using perfusate with supplemental oxygen replicates near physiological parameters thus being a promising strategy for organ preservation. Nevertheless, optimum perfusion parameters are difficult to establish in pancreas transplantation given its complex vascular anatomy combined with an intrinsically low blood flow. The objective of this work is to analyze the results published in the recent literature relating to the considerations of ex-vivo normothermic graft perfusion machines and their usefulness in the field of pancreas transplantation.
Insights
Pancreas transplantation offers a cure for type-1 diabetes. Ex-vivo normothermic perfusion machines may improve donor organ selection, enhancing transplant success rates.
Area of Science:
- Transplantation immunology
- Organ preservation techniques
- Diabetes mellitus management
Background:
- Pancreas transplantation is the sole curative treatment for type-1 diabetes, maintaining normoglycemia.
- Transplant rates have declined due to donor quality issues and subjective donor assessment.
- Donor selection relies on morphological, functional, and clinical variables, often with surgeon's subjective evaluation.
Purpose of the Study:
- To review literature on ex-vivo normothermic graft perfusion machines in pancreas transplantation.
- To assess the utility of these machines in improving donor organ selection and preservation.
- To analyze objective criteria for donor assessment facilitated by perfusion technology.
Main Methods:
- Literature review of studies on ex-vivo normothermic perfusion in pancreas transplantation.
- Analysis of morphological and functional parameters assessed during perfusion.
- Evaluation of perfusion machine impact on donor organ assessment and decision-making.
Main Results:
- Graft perfusion machines offer objective morphological and functional criteria for donor assessment.
- Normothermic perfusion with oxygenation mimics physiological conditions for organ preservation.
- Challenges remain in optimizing perfusion parameters due to pancreas' complex vascular anatomy and low blood flow.
Conclusions:
- Ex-vivo normothermic perfusion machines show promise for improving pancreas donor organ selection.
- Objective criteria from perfusion technology can reduce subjectivity in donor assessment.
- Further research is needed to establish optimal perfusion parameters for pancreas transplantation.
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