Karcz Marcin, Cook H Terence, Sibbons Paul, Gray Cathy, Dorling Anthony, Papalois Vassilios
West London Renal and Transplant Centre, Imperial College Kidney and Transplant Institute, Middlesex, United Kingdom.
Exp Clin Transplant. 2010 Mar;8(1):55-60.
Hypothermic machine perfusion is a well-established preservation method for kidneys that allows for better preservation over longer periods and pretransplant assessment of graft viability. This technique has only sporadically been used for pancreatic grafts. The aim of this study was to establish a hypothermic machine perfusion model for porcine pancreas perfusion.
Fifteen porcine pancreata were subjected to 25 minutes of warm ischemia and 149 minutes of cold ischemia before undergoing meticulous bench work preparation and perfusion, via an aortic segment, on the RM3 perfusion machine with University of Wisconsin (Barr Laboratories Inc., Pomona, NY, USA) solution. Perfusion variables (degrees C, temperature; mm Hg, systolic perfusion pressure; mL/min, flow volume; mm Hg/mL/min, resistance) were recorded every 30 minutes. Tissue samples were assessed for each pancreas preperfusion and postperfusion using a semiquantitative scoring scale to grade histopathologic changes: acinar cell damage (0-4), islet cell damage (0-3), inflammation (0-3), and edema (0-3).
Hypothermic machine perfusion time was set at 315 minutes, and all grafts were maintained between 4-10 degrees C. The results were as follows (range, mean -/+ SD): systolic perfusion pressures were 5-13 mm Hg (9.61 -/+ 3.25 mm Hg) during the first 60 minutes (priming), and 15-23 mm Hg (21.07 -/+ 4.26 mm Hg) during the maintenance period. Target flow volumes reached 141-152 mL/min (147.6 -/+ 8.969 mL/min) at 60 pulses per minute. Intrapancreatic resistance decreased throughout priming to 0.03-0.09 mm Hg/mL/min (0.083 -/+ 0.042 mm Hg/mL/min), and remained unchanged until completion of perfusion. Pancreatic weight increase varied from 3.2% to 18.3% (13.36% -/+ 4.961%). There was significant postperfusion reduction in islet and acinar cell damage (P = .001 and P = .01 respectively).
We have developed a model of machine perfusion for porcine pancreata which is simple, reliable, and protects graft histopathologic integrity. The model can be used in further studies to improve the quality of pancreas preservation, and assess and improve the viability of the condition of borderline pancreatic grafts.
低温机器灌注是一种成熟的肾脏保存方法，能在更长时间内实现更好的保存效果，并可在移植前评估移植物的活力。该技术仅偶尔用于胰腺移植物。本研究的目的是建立猪胰腺灌注的低温机器灌注模型。
15个猪胰腺在经历25分钟的热缺血和149分钟的冷缺血后，进行细致的台上准备工作，然后通过主动脉段，在RM3灌注机上用威斯康星大学溶液（美国纽约州波莫纳市巴尔实验室公司）进行灌注。每30分钟记录灌注变量（摄氏度，温度；毫米汞柱，收缩期灌注压；毫升/分钟，流量；毫米汞柱/毫升/分钟，阻力）。在灌注前和灌注后，使用半定量评分量表对每个胰腺的组织样本进行评估，以对组织病理学变化进行分级：腺泡细胞损伤（0 - 4级）、胰岛细胞损伤（0 - 3级）、炎症（0 - 3级）和水肿（0 - 3级）。
低温机器灌注时间设定为315分钟，所有移植物维持在4 - 10摄氏度。结果如下（范围，平均值±标准差）：在最初60分钟（预充期）收缩期灌注压为5 - 13毫米汞柱（9.61±3.25毫米汞柱），在维持期为15 - 23毫米汞柱（21.07±4.26毫米汞柱）。在每分钟60次脉冲时，目标流量达到141 - 152毫升/分钟（147.6±8.969毫升/分钟）。胰腺内阻力在预充期全程下降至0.03 - 0.09毫米汞柱/毫升/分钟（0.083±0.042毫米汞柱/毫升/分钟），并在灌注完成前保持不变。胰腺重量增加幅度为3.2%至18.3%（13.36%±4.961%）。灌注后胰岛和腺泡细胞损伤显著减轻（分别为P = 0.001和P = 0.01）。
我们已经开发出一种用于猪胰腺的机器灌注模型，该模型简单、可靠，并能保护移植物的组织病理学完整性。该模型可用于进一步研究，以提高胰腺保存质量，并评估和改善临界胰腺移植物的存活状态。
