title: The effect of clinical and biochemical donor parameters on pancreatic islet isolation yield from cadaveric organ donors.
abstract: The recovery of pancreatic islet cells from cadaveric donors for allotransplantation may depend on the functional condition of the pancreas of the donor prior to organ harvesting. We examined donor hemodynamic and biochemical parameters and their effects on the subsequent yield of islet cells after harvesting. All pancreata were flushed and preserved in University of Wisconsin (UW) solution and digested using automated method within 8 hours. In the first analysis, digestions were divided into high-yield (> 2000 IEQ/g pancreas), and low-yield (< 2000 IEQ/g) groups and donor variables were averaged for each group. Donors whose pancreata yielded > 2000 IEQ/g received significantly greater amounts of Dopamine (14.43 micrograms/kg/min vs 9.35 mg/kg/min, p = 0.05). The daily urine output between groups was also significantly different. Maximum systolic blood pressure (SBP), minimum systolic blood pressure, use of vasopressin, length of hospitalization, and maximum base deficit were compared between the two groups. Less severe hypoglycemia (lowest blood glucose 143 mg/dL vs 107 mg/dL, p = 0.02) and lower amylase levels (36.2 U vs 80.7, p = 0.07 were noted in the high-yield group. A trend towards higher islet yields was associated with lowest hourly urine output > 60 (2040 IEQ/g vs 1649 IEQ/g p = 0.09), maximum SBP > 200 (2097 vs 1673, p = 0.07, and surprisingly, lowest SBP below 80 (2013 vs 1742, p < 0.1). Amount of fluids administered prior to procurement had no influence on islet yield. In conclusion, hemodynamic variables such as urine output, systolic blood pressure, and degree of pressor support were modestly associated with successful islet isolation. The preliminary data suggest that better multifactor donor analysis is imperative for standardization and monitoring of multiorgan donors. The association of higher blood glucose levels with successful isolation may also be related to resuscitation with dextrose-containing fluids.
authors.affiliation: Department of Surgery, College of Physicians and Surgeons of Columbia University, New York, USA.
authors.forename: P
authors.initials: P
authors.lastname: Fiedor
authors.forename: E R
authors.initials: ER
authors.lastname: Goodman
authors.forename: R S
authors.initials: RS
authors.lastname: Sung
authors.forename: J
authors.initials: J
authors.lastname: Czerwiński
authors.forename: W
authors.initials: W
authors.lastname: Rowiński
authors.forename: M A
authors.initials: MA
authors.lastname: Hardy
mesh_terms: D000241:Adenosine; D000293:Adolescent; D000328:Adult; D000493:Allopurinol; D000818:Animals; D002102:Cadaver; D002469:Cell Separation; D003921:Diabetes Mellitus, Experimental / Q000601:surgery; D005978:Glutathione; D006439:Hemodynamics; D006801:Humans; D007328:Insulin / Q000097:blood; D007515:Islets of Langerhans / Q000166:cytology; D016381:Islets of Langerhans Transplantation / Q000502:physiology; D008875:Middle Aged; D019188:Organ Preservation Solutions; D011887:Raffinose; D051381:Rats; D014019:Tissue Donors / Q000145:classification / Q000706:statistics & numerical data; D014021:Tissue Preservation / Q000379:methods; D014183:Transplantation, Heterologous; D014184:Transplantation, Homologous
chemical_list: D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose