Elzawahry Mohamed A, Reichman Trevor, Sutherland Andrew
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK; Oxford Transplant Centre, Headington, Oxford, UK.
Ajmera Transplant Centre, Toronto General Hospital, University Health Network; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
Curr Opin Organ Transplant. 2025 Aug 1;30(4):279-288. doi: 10.1097/MOT.0000000000001224. Epub 2025 May 2.
Pancreas and islet transplantation face critical organ shortage challenges, with many potential grafts discarded due to concerns about consequences of ischemia-reperfusion injury, particularly from donation after circulatory death (DCD) donors. Static cold storage remains standard practice but has significant limitations. Novel preservation technologies may improve transplant outcomes, donor selection and even expand the donor pool.
Normothermic regional perfusion in DCD donors has increased pancreas utilization with promising one-year graft survival comparable to donation after brain-death (DBD) donors. Hypothermic machine perfusion maintains tissue integrity and shows promising preclinical results. Oxygenated hypothermic machine perfusion successfully restores tissue adenosine triphosphate (ATP) levels without notable tissue injury. Normothermic machine perfusion, despite challenges, offers potential for viability assessment and resuscitation.
Advanced preservation technologies provide platforms for assessment, reconditioning, and therapeutic interventions for pancreas grafts. Clinical translation requires consensus on perfusion parameters and perfusate composition optimized for pancreatic preservation. Future developments should focus on implementing sensitive and specific assessment methods, including beta-cell specific biomarkers, to confidently select and utilize marginal pancreas grafts for transplantation.
胰腺和胰岛移植面临着严重的器官短缺挑战，许多潜在的移植物因担心缺血再灌注损伤的后果而被丢弃，尤其是来自心脏死亡后捐赠（DCD）供体的移植物。静态冷藏仍然是标准做法，但有显著局限性。新型保存技术可能会改善移植结果、供体选择，甚至扩大供体库。
DCD供体的常温区域灌注提高了胰腺利用率，其一年移植物存活率有望与脑死亡后捐赠（DBD）供体相当。低温机器灌注可维持组织完整性，并显示出有前景的临床前结果。氧合低温机器灌注成功恢复了组织三磷酸腺苷（ATP）水平，且无明显组织损伤。常温机器灌注尽管存在挑战，但为活力评估和复苏提供了可能。
先进的保存技术为胰腺移植物的评估、修复和治疗干预提供了平台。临床转化需要就针对胰腺保存优化的灌注参数和灌注液成分达成共识。未来的发展应侧重于实施敏感且特异的评估方法，包括β细胞特异性生物标志物，以便有信心地选择和利用边缘性胰腺移植物进行移植。
