Abstract
Outcome after pancreas and islet transplants have consistently improved. The reasons are multifactorial, including better recipient care with respect to surgical and isolation techniques, immunosuppressive regimens and preservation protocol. In this review, we summarize the recent literature regarding the current advances in pancreas preservation. A hypothermic pulsatile machine perfusion method, developed and widely used for clinical kidney transplants, was not applied for clinical pancreas transplantation. A simple cold storage method is the most widely used preservation method for all solid organs. The University of Wisconsin(UW) solution has been the standard preservation solution for the pancreas for almost 20 years. Colloid-free Celsior and histidine-tryptophan-ketoglutarate preservation solutions are equivalent to UW solution for cold storage before pancreas transplant.
A two-layer cold storage method (TL), developed at Kobe University, consists of a perfluorochemical and cold storage solution that can supply oxygen to the pancreas graft during preservation. A number of studies on human pancreas have reported the beneficial effect of TL on islet isolation outcomes since 2000. Recently, TL, using M-Kyoto solution instead of UW solution, and pancreatic ductal injection with trypsin inhibitor have reported promising outcomes in human islet isolation and transplant.
Further studies are needed to increase the availability of marginal and non-heart beating donors in pancreas transplant and to achieve single-donor islet transplantation.
