Coordinator of Transplantation / Technician of islet isolation
Department of General and Transplantation Surgery
Infant Jesus Hospital
Machine Perfusion of a pancreas prior to islets isolation allows to better islets yield in Clinical Islets Transplantation
Łukasz Górski1, Michał Wszoła1, Andrzej Berman1, Agata Ostaszewska1, Robert Kuthan2, Marta Serwańska Świętek1, Andrzej Chmura1, Artur Kwiatkowski1.
1Department of General and Transplantation Surgery, Infant Jesus Hospital, Warsaw, Poland; 2Department of Medical Microbiology, Infant Jesus Hospital, Warsaw, Poland
Polish Program of Islet Transplantation.
Islets transplantation is still developing method of cure for brittle diabetes. Since 1999 only in Europe more than 20 new isolation and transplantation centres have been established. Starting a program is difficult because islets isolation process is unstable and depends on many variables, which leads to the fact that no more than 50% of isolation is finished with transplantation. The program of islets transplantation lasts in Poland less than 5 years and is still developing.
The aim of this study was comparing donors and isolation data between successful and unsuccessful islets isolation.
Material and methods. In Department of General and Transplantation Surgery 15 isolation of Langerhans islets have been performed - 10 for Islets Allotransplantation and 5 for autotransplantation. 6 Allo-isolation have been finished with islets transplantation -60% (n=6 group ITx) and four were unsuccessful – 40% - due to low pancreatic islets yield (n=4 group control). Donors, procurement and isolation data were collected in order to find differences. Machine Perfusion (MP) and Cold Storage (CS) were methods of preservation organs prior to isolation. MP was performed with use of LifePort device with systolic pressure set on 15 mmHg.
Results. 70% of donors were male, mean age was 43±11 years with mean weight 83±16 kg and mean BMI 26±3 kg/m2. Mean ICU stay was 5,8±2,5 days, mean serum amylase was 279±232 U and mean P-PASS was 18,8±3. Mean CIT till starting isolation process was 195±90 minutes. 40% of pancreas prior to isolation were kept in MP and 60% were kept in CS. Mean islets yield after isolation were 107000 IEQ vs. 344000 IEQ in control and ITx group respectively (p=0.02). The only difference in donors data between control and ITx group was serum level of amylase respectively 395 vs. 201 U, although it did not reach statistical value. Pancreas in ITx group prior to isolation, more often were kept in MP – 66% vs. 0% in control group (p= 0.02). Mean volume of perfusion solution used for collagenase preparation was lower in control group – 175 ml vs. 340 ml in ITx group (p=0.01). Mean time of pancreas preparation prior to starting digestion was significantly longer in control group 55 min vs. 30 min in ITx group (p=0.05). Mean tissue which was left after digestion was lower in control group – 3,5 grams vs. 33 grams in ITx group and the difference was close to statistical significance (p=0.09) – there were no difference in pancreas weight between the groups.
Conclusions. Machine Perfusion of pancreas prior to islets isolation allows for higher islets yield. To improve islets isolation process higher volume of perfusion solution should be used for digestion. Preparation of pancreas should be fast and efficient.
15:30 - 17:00
|Pancreas & Islet Donors: Assessing Risk and Optimizing Outcomes||Machine Perfusion of a pancreas prior to islets isolation allows to better islets yield in Clinical Islets Transplantation||Room 110|