Good functionality but lower yield after islet isolation from dona­tion after circulatory death pancreata

J.B. Doppenberg, H. Putter, M.F. Nijhoff, M.A. Engelse, E.J.P de Koning

Thursday 10 march 2016

15:20 - 15:30h at Zaal 1 & 2

Categories: Parallelsessie (klinisch)

Parallel session: Parallelsessie XII - Klinisch

Donation after circulatory death (DCD) is increasingly performed due to a shortage of donation after brain death (DBD) organs. However, for islet isolation and transplantation there are concerns about islet yield and islet graft function. We investigated the use of DCD pancreata for islet isolation and transplantation. Islet isolation procedures from 192 DBD and 93 DCD donor pancreata between 2008-2014 were studied. Donor and procurement characteristics were compared between DBD and DCD groups and were corrected for mismatched covariates (UNIANOVA). The number of isolated islets expressed as islet equivalents (IEQ), purity, and tissue volume were quantified after every isolation, and were repeated on day 1 and day 3 during culture. Dynamic glucose-stimulated insulin secretion was performed if clinical transplantation was considered. Since 2011 DCD islets were used in human transplantation procedures in combination with DBD islets. Three months after transplantation mixed meal tests were performed. Islet yield differed significantly after isolation (day 0) (437,603 IEQ (DBD) and 343,418 (DCD, p<0.001). DBD islet isolations yielded a larger final volume (+26.8±4.38 µL, p= 0.014) and maximum purity (+5.00±2.01%, p=0.013). After medium changes IEQ was 378,470 (day 1) and 294,715 (day 3) for DBD islets and 291,279 (day 1) and 218,444 (day 3) for DCD islets (p<0.05 for DBD vs. DCD IEQs and p<0.001 for IEQ change per day). Importantly, the percentage decrease in IEQ from day 0 to 1 and day 0 to 3 did not differ between DBD and DCD groups (p=0.478 and p=0.732, respectively). DCD related ischemia times were not related to islet yield. Insulin secretion was not different between DBD and DCD islets (peak SI: 4.6±0.3 (DBD, n=82) and 5.4±1.3 (DCD, n=13), p=NS). Transplantations using DBD single grafts or double grafts (DBD+DBD or DBD+DCD), showed no difference in AUC C-peptide/(IEQ/kg recipient) in mixed meal tests (p=0.077). In conclusion, isolations from DCD pancreata generated a lower islet yield compared to DBD pancreata but DCD and DBD islets showed similar islet functionality. DCD islets should strongly be considered in clinical islet transplantation.