title: Use of Ex Vivo Normothermic Perfusion for Quality Assessment of Discarded Human Donor Pancreases.
abstract: A significant number of pancreases procured for transplantation are deemed unsuitable due to concerns about graft quality and the associated risk of complications. However, this decision is subjective and some declined grafts may be suitable for transplantation. Ex vivo normothermic perfusion (EVNP) prior to transplantation may allow a more objective assessment of graft quality and reduce discard rates. We report ex vivo normothermic perfusion of human pancreases procured but declined for transplantation, with ABO-compatible warm oxygenated packed red blood cells for 1-2 h. Five declined human pancreases were assessed using this technique after a median cold ischemia time of 13 h 19 min. One pancreas, with cold ischemia over 30 h, did not appear viable and was excluded. In the remaining pancreases, blood flow and pH were maintained throughout perfusion. Insulin secretion was observed in all four pancreases, but was lowest in an older donation after cardiac death pancreas. Amylase levels were highest in a gland with significant fat infiltration. This is the first study to assess the perfusion, injury, as measured by amylase, and exocrine function of human pancreases using EVNP and demonstrates the feasibility of the approach, although further refinements are required.
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Biomedical Research Campus, Cambridge, UK.
authors.forename: A D
authors.initials: AD
authors.lastname: Barlow
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Biomedical Research Campus, Cambridge, UK.
authors.forename: M O
authors.initials: MO
authors.lastname: Hamed
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Biomedical Research Campus, Cambridge, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Mallon
authors.affiliation: NIHR Biomedical Research Campus, Cambridge, UK.|Department of Histopathology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: R J
authors.initials: RJ
authors.lastname: Brais
authors.affiliation: NIHR Biomedical Research Campus, Cambridge, UK.|Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
authors.forename: F M
authors.initials: FM
authors.lastname: Gribble
authors.affiliation: NIHR Biomedical Research Campus, Cambridge, UK.|Department of Haematology, Addenbrooke's Hospital, Cambridge, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: Scott
authors.affiliation: NIHR Biomedical Research Campus, Cambridge, UK.|Cancer Research UK Cambridge Institute, University of Cambridge, Cambridge, UK.
authors.forename: W J
authors.initials: WJ
authors.lastname: Howat
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Biomedical Research Campus, Cambridge, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Bradley
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Biomedical Research Campus, Cambridge, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Bolton
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Biomedical Research Campus, Cambridge, UK.
authors.forename: G J
authors.initials: GJ
authors.lastname: Pettigrew
authors.affiliation: Division of Transplant Surgery, University of Leicester, Leicester, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Hosgood
authors.affiliation: Division of Transplant Surgery, University of Leicester, Leicester, UK.
authors.forename: M L
authors.initials: ML
authors.lastname: Nicholson
authors.affiliation: Department of Surgery, University of Cambridge, Cambridge, UK.|NIHR Biomedical Research Campus, Cambridge, UK.
authors.forename: K
authors.initials: K
authors.lastname: Saeb-Parsy
mesh_terms: D000293:Adolescent; D000328:Adult; D000681:Amylases / Q000378:metabolism; D000066491:Clinical Decision-Making; D051799:Delayed Graft Function / Q000175:diagnosis / Q000378:metabolism / Q000517:prevention & control*; D046148:Donor Selection; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D017063:Outcome Assessment, Health Care; D016035:Pancreas Transplantation; D010477:Perfusion / Q000379:methods*; D013696:Temperature; D020858:Tissue and Organ Harvesting
chemical_list: D000681:Amylases
keywords: Ischaemia reperfusion injury (IRI); organ perfusion and preservation