Doppenberg Jason B, van Rooden Rutger M, van Dijk Madeleine C, de Goeij Femke H C, van der Heijden Fenna J, Alwayn Ian P J, de Koning Eelco J P, de Jonge Jeroen, Engelse Marten A, Huurman Volkert A L
Department of Surgery, Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.
Department of Surgery, Erasmus Medical Center, Transplant Institute, Rotterdam, The Netherlands.
Am J Transplant. 2025 Mar;25(3):594-601. doi: 10.1016/j.ajt.2024.09.034. Epub 2024 Oct 2.
Abdominal normothermic regional perfusion (aNRP) is an in situ normothermic oxygenated donor perfusion technique before procurement during controlled donation after circulatory death (cDCD) procedures and allows for organ quality evaluation. There are few data on the effect of aNRP on pancreatic islet isolation and subsequent transplantation outcomes. We aim to evaluate the impact of aNRP on cDCD pancreatic islet isolation and transplantation. A retrospective analysis was performed on pancreatic islet isolation outcomes from aNRP, cDCD, and donation after brain death pancreases. Isolations were compared to previous donor age (60-75 years) matched isolations. Islet function was assessed by a dynamic glucose-stimulated insulin secretion. Donor baseline characteristics did not differ among groups. Isolations from aNRP pancreases (471 739 islet equivalents [IEQ] [655 435-244 851]) yielded more islets compared to cDCD (218 750 IEQ [375 951-112 364], P < .01) and to donation after brain death (206 522 IEQ [385 544-142 446], P = .03) pancreases. Dynamic glucose-stimulated insulin secretion tests in 7 aNRP islet preparations showed a mean stimulation index of 4.91, indicating good functionality. Bilirubin and alanine aminotransferase during aNRP correlated with islet yield (r = 0.685, P = .002; r = 0.491, P = .016, respectively). Islet isolation after aNRP in cDCD donors results in a high islet yield with viable functional islets. aNRP could increase the utilization of the pancreases for islet transplantation.
腹部常温区域灌注（aNRP）是一种在循环性死亡后可控捐赠（cDCD）过程中获取器官前的原位常温氧合供体灌注技术，可用于评估器官质量。关于aNRP对胰岛分离及后续移植结果的影响，相关数据较少。我们旨在评估aNRP对cDCD胰岛分离及移植的影响。对来自aNRP、cDCD和脑死亡后捐赠胰腺的胰岛分离结果进行了回顾性分析。将分离结果与先前年龄匹配（60 - 75岁）的供体分离结果进行比较。通过动态葡萄糖刺激胰岛素分泌来评估胰岛功能。各组供体基线特征无差异。与cDCD（218750胰岛当量[IEQ][375951 - 112364]，P < 0.01）和脑死亡后捐赠（206522 IEQ[385544 - 142446]，P = 0.03）的胰腺相比，aNRP胰腺的分离（471739胰岛当量[IEQ][655435 - 244851]）产生的胰岛更多。对7个aNRP胰岛制剂进行的动态葡萄糖刺激胰岛素分泌试验显示平均刺激指数为4.91，表明功能良好。aNRP期间的胆红素和丙氨酸转氨酶与胰岛产量相关（分别为r = 0.685，P = 0.002；r = 0.491，P = 0.016）。cDCD供体经aNRP后的胰岛分离可产生高产量且具有活性功能的胰岛。aNRP可提高胰腺用于胰岛移植的利用率。
