Introduction. Pancreas or islet transplantation is considered the most effective treatment for patients with type 1 diabetes mellitus. Due to the persistent organ shortage, pancreata from marginal donors are more frequently used for transplantation or islet isolation. These grafts are more vulnerable to ischemic damage. The traditional preservation method, cold storage (CS), might not be sufficient to completely prevent this damage. It is hypothesized that hypothermic machine perfusion (HMP) can improve the quality of the donor pancreas by an increase in viability and a reduction in injury compared to CS.

Methods. In this study, 8 human pancreata (4 DCD and 4 DBD) were preserved by HMP and 8 (4 DCD and 4 DBD) by CS. HMP was performed for 6 hours with oxygenated Belzer UW-MPS® with dual perfusion of the mesenteric superior artery and the splenic artery. Tissue biopsies and samples of the preservation fluid were collected at baseline and after 6 hours of preservation by either HMP or CS.

Results. At baseline, the ATP content in the DCD group (8,2 +- 5,6 ¯o;mol/gram protein) was significantly lower than in the DBD group (43,5 +- 16,2 ¯o;mol/gram protein). After 6 hours of CS, the ATP content decreased to 4,2 +- 1,7 (DCD) and 25,6 +- 8,6 (DBD) ¯o;mol/gram protein. In the HMP preserved pancreata, the ATP content increased to 47,9 +- 25 (DCD) and 136,4 +- 144 (DBD) ¯o;mol/gram protein. In the DCD group, the ATP content after HMP was significant higher compared to CS and it was equivalent to the ATP content at baseline in the DBD group. During HMP, amylase, lipase and LDH levels in the preservation fluid increased. Lipase and LDH levels reached a plateau after 5 hours of HMP.

Conclusion. HMP seems to improve donor pancreata quality, demonstrated by the increased levels of ATP and potentially by washing out degrading enzymes. Therefore, we propose that DCD pancreata preserved by HMP could reach the quality of DBD pancreata and could be considered transplantable.

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