11. Oxygenated hypothermic machine perfusion of the pancreas followed by controlled oxygenated rewarming to sub-normothermia for viability testing

L.J.M. Habets, J.B. Doppenberg, I.P.J. Alwayn, M.A. Engelse, V.A.L. Huurman

Wednesday 4 march 2020

0:00 - 0:00h at Toon Hermans Foyer

Parallel session: Postersessie 3 – Klinische abstracts

Background: Pancreas transplantation is the treatment of choice in a selected group of patients with type 1 diabetes. Machine preservation techniques have the potential of increasing organ quality and utilization, by allowing vitality and functionality assessment while reconditioning the pancreas. A protocol for a novel combination of consecutive preservation techniques in pancreata was established and tested.

Methods: Two human pancreata disregarded for clinical use were used for this experiment. The superior mesenteric artery, splenic artery and pancreatic duct were identified and cannulated on the backtable. Furthermore, an anastomosis was created between the distal splenic artery and vein. The pancreata endured f static cold storage respectively followed by preservation applying 2h of Hypothermic Machine Perfusion (HMP), 1h Controlled Oxygenated Rewarming (COR) and 1h of sub-Normothermic Machine Perfusion (sNMP) using a Kidney Assist perfusion machine. Belzer UW MPS was used for HMP, and perfusate solutions for COR-sNMP differed between the experiments. Respectively DMEM and Williams-E medium combined with Albumin was used. Biopsies were taken for histologic examination using HE A previously published scoring system (grade 0 – 2) was used focusing on edema, vacuolization and acinar integrity loss.

Results: During perfusion, the human pancreata demonstrated stable perfusion parameters. The experimental vascular anastomosis between the Splenic Artery and Splenic Vein increased total flow marginally. Temperature was consistently 5⁰C during HMP in one pancreas, while the other remained 10⁰C (40 ml/min vs. 15 ml/min). Laboratory analyses of pancreatic fluid collected from the pancreatic duct showed high contents of amylase. pH levels were 7.34 and 7.6 at the end of sNMP, lactate climbed in both cases to 2.63 and 4.79 mmol/L. from 2.43 and 4.33 mmol/L. Grade 2 edema was observed in both pancreata.

Conclusions: Consecutive techniques of machine perfusion were deemed technically feasible. However, further alterations to the protocol are required for preventing extensive formation of edema. Future perfusion experiments will focus on providing a stable sNMP perfusion environment for assessment of flow and viability parameters, which might ultimately lead to an increase in pancreas graft utilization.