Functional and structural integrity of porcine pancreatic grafts subjected to a period of warm ischemia and cold preservation with histidine-tryptophan-ketoglutarate (custodiol) or University of Wisconsin solution.
BACKGROUND
University of Wisconsin (UW) solution (Viaspan) is currently used to preserve organs from nonheartbeating donors. Histidine-tryptophan-ketoglutarate (HTK) solution (Custodiol) is of proven efficacy in experimental pancreas preservation, but its efficacy in combined warm ischemia (WI) and cold ischemia (CI) is unknown. The viability of HTK-preserved porcine pancreatic grafts was assessed after various periods of WI and compared with grafts flushed and preserved with UW solution.


METHODS
A total of 14 pigs were used: G1 (n=4, UW) and G2 (n=4, HTK) with 15-min WI and 16-hr cold storage; G3 (n=3, UW) and G4 (n=3, HTK) with 30-min WI and 16-hr cold storage.


RESULTS
All animals in G1 and G2 were normoglycemic, whereas only 66% of pancreases were functioning in G3 and G4. HTK perfusion was associated with increased wet weight. Transient hyperinsulinemia was noted in all the groups on postoperative day 1 (mean range: 8.9-12.4 microU/L). Postoperative serum amylase and lipase were more pronounced in G3 and G4. However, HTK-stored grafts exhibited less evidence of biochemical pancreatitis as compared with UW-stored grafts on the first postoperative day in the group with 15-min WI. Mean K values of intravenous glucose tolerance tests on postoperative day 14 were similar in both groups. Vascular congestion was uniformly observed and was considered a typical feature of WI.


CONCLUSIONS
Porcine pancreatic grafts are viable after 16-hr CI following 15-min WI in this experimental nonheartbeating donor model. HTK solution seems to provide reliable graft function in this setting and to be equivalent to UW.
Troisi
Roberto
R
Deparment of General, Hepato-Biliary and Transplantation Surgery, Ghent University Hospital, Gent, Belgium. roberto.troisi@rug.ac.be
Meester
Daniel
D
Van Den Broecke
Carolien
C
Cuvelier
Claude A
CA
Fiers
Tom
T
de Hemptinne
Bernard
B
Hesse
Uwe J
UJ
D000241:Adenosine / Q000494:pharmacology*; D000493:Allopurinol / Q000494:pharmacology*; D000681:Amylases / Q000097:blood; D000818:Animals; D003080:Cold Temperature; D004487:Edema / Q000097:blood / Q000473:pathology; D005978:Glutathione / Q000494:pharmacology*; D006085:Graft Survival / Q000187:drug effects*; D006358:Hot Temperature; D006946:Hyperinsulinism / Q000097:blood / Q000473:pathology; D007003:Hypoglycemia / Q000097:blood / Q000473:pathology; D007328:Insulin / Q000494:pharmacology*; D008049:Lipase / Q000097:blood; D023421:Models, Animal; D009926:Organ Preservation; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D010179:Pancreas / Q000473:pathology / Q000502:physiology; D016035:Pancreas Transplantation; D011887:Raffinose / Q000494:pharmacology*; D015427:Reperfusion Injury / Q000097:blood / Q000473:pathology*; D013552:Swine
D007328:Insulin; D019188:Organ Preservation Solutions; C055206:University of Wisconsin-lactobionate solution; D000493:Allopurinol; D008049:Lipase; D000681:Amylases; D005978:Glutathione; D000241:Adenosine; D011887:Raffinose