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Donation After Circulatory Death Islets are Comparable to Standard-of-Care Donation After Brain Death Islets:
Meirigeng Qi1, Keiko Omori1, Christopher Orr1
1Department of Translational Research and Cellular Therapeutics, Arthur Riggs Diabetes & Metabolism Research Institute, City of Hope National Medical Center, Duarte, CA.
Background:
Transplantation of isolated human islets is a valuable therapy for individuals with severe type 1 diabetes. A shortage of suitable pancreata and islets hinders access to islet transplantation (IT). Organ donation after circulatory death (DCD) islets are believed inferior and not appropriate for clinical IT. We readdressed this and compared outcomes between DCD and standard-of-care donation after brain death (DBD) islets.
Methods:
The data sample comprised 801 human islet isolations >2 decades from a single IT center. Islets from DCD and DBD donor organs were compared for islet outcome and quality. In some instances, a noninferior equivalency analysis was performed.
Results:
Across the study interval, islet yield, viability, and function remained high despite a deterioration in donor health biometrics. Noninferior analysis demonstrated that DCD islets were equivalent to DBD islets in islet yield post-culture and in murine diabetes reversion. In fact, in vivo islet function trended to more diabetes reversal in mice receiving DCD islets versus animals given DBD islets (75% versus 67%). As well, no significant differences were observed between groups in age, body mass index, pancreas cold ischemia time, digestion switch time, islet yield (success >250 000 islet equivalent), purity (>80%), recovery (>75%), post-culture viability, transplantable preparations, or insulin stimulation index. The median days of hospitalization and warm ischemia time were significantly greater in DCD versus the DBD group. Predictably, elevated donor hemoglobin A1c negatively impacted islet quality regardless of donation death status.
Conclusions:
Results from islet isolations >2 decades from a single center are presented. DCD islets were found to be equivalent to DBD islets on several relevant metrics. These findings encourage wider use of DCD donor islets for clinical IT.
