Department of Surgery, Imperial College London, London, UK.
Curr Diab Rep. 2019 Jul 10;19(8):56. doi: 10.1007/s11892-019-1165-y.
Pancreas transplantation enables complete patient independence from exogenous insulin administration and increases both patient survival and quality of life. Despite this, there has been a decline in pancreas transplantation for the past 20 years, influenced by changing donor demographics with more high-risk extended criteria (ECD) and donation after cardiac death (DCD) donors. This review discusses whether the advent of machine perfusion (MP), if extended to the pancreas, can increase the pool of suitable donor organs.
Hypothermic and normothermic MP, as forms of preservation deemed superior to cold storage for high-risk kidney and liver donor organs, have opened the avenue for translation of this work into the pancreas. Recent experimental models of porcine and human ex-vivo pancreatic MP are promising. Applications of MP to the pancreas however need refinement-focusing on perfusion protocols and viability assessment tools. Emerging research shows pancreatic MP can potentially offer superior preservation capacity, the ability to both resuscitate and manipulate organs, and assess functional and metabolic organ viability. The future of MP will lie in organ assessment and resuscitation after retrieval, where ultimately organs initially considered high risk and unsuitable for transplantation will be optimised and transformed, making them then available for clinical use, thus increasing the pool of suitably viable pancreata for transplantation.
胰腺移植使患者完全摆脱外源性胰岛素的依赖，提高了患者的生存率和生活质量。尽管如此，在过去的 20 年中，由于供体人群的变化，包括更多的高风险扩展标准（ECD）和心脏死亡后供体（DCD），胰腺移植的数量有所下降。本综述讨论了如果将机器灌注（MP）应用于胰腺，是否可以增加合适供体器官的数量。
作为一种被认为优于低温保存的保存方法，低温和常温 MP 已应用于高危肾脏和肝脏供体器官，为将这项工作应用于胰腺开辟了道路。最近的猪和人离体胰腺 MP 实验模型很有前途。然而，MP 在胰腺中的应用需要进一步改进，重点是灌注方案和活力评估工具。新出现的研究表明，胰腺 MP 可能具有更好的保存能力，既能复苏又能操作器官，并能评估器官的功能和代谢活力。MP 的未来在于器官的评估和复苏，在这一过程中，最初被认为是高危且不适合移植的器官将被优化和转化，从而使其可用于临床应用，从而增加可用于移植的合适胰腺的数量。
