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Pancreas Procurement and Preservation for Islet Transplantation: Personal Considerations

DOI: 10.1155/2011/783168

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Pancreatic islet transplantation is a promising option for the treatment of type 1 diabetic patients. After the successful demonstration of the Edmonton protocol, islet transplantation has advanced significantly on several fronts, including improved pancreas procurement and preservation systems. Since we frequently use pancreata from donors after cardiac death in Japan,we have applied the in situ regional organ cooling system for pancreas procurement to reduce the warm ischemic time. To reduce the apoptosis of pancreatic tissue during cold preservation, we have applied the ductal injection of preservation solution. For pancreas preservation, we use modified Kyoto solution, which is advantageous at trypsin inhibition and less collagenase inhibition. In this paper, we show pancreas procurement and preservation in our group for islet transplantation. 1. Introduction Diabetes mellitus is a devastating disease, and over 200 million people are affected worldwide, thus representing about 6% of the world population. Type 1 diabetes results from the autoimmune-mediated destruction of insulin-secreting β cells in the islets of Langerhans of the pancreas. Pancreatic islet transplantation represents a viable option for the treatment of patients with unstable type 1 diabetes mellitus with frequent severe hypoglycemia and hypoglycemia unawareness [1, 2]. Recent advances in islet transplantation, including the utilization of donors after cardiac death (DCD) [3–6], single-donor islet transplantation [7–10], and living-donor islet transplantation [11], were based on advanced pancreas transport systems [9, 12, 13], improved islet isolation methods [14–17], enhanced islet engraftment [18–21], and revised immunosuppressant protocols [6, 14, 22]. One of the most important issues affecting islet transplantation is concerned with donor quality [23]. Several critical donor factors have been identified, including donor age, body mass index (BMI), cause of death, usage of vasopressor, hypotensive episode, length of hospitalization, blood glucose levels, transaminases level, creatinine levels, cold preservation time, and procurement team [23–26]. Therefore, effective pancreas procurement and preservation are important for successful islet isolation and transplantation. In this paper, the current advances in pancreas procurement and preservation for islet transplantation in our group are described. 2. Pancreas Procurement Pancreata from donors with brain death (DBD) are procured using a standardized technique to minimize warm ischemia. A preservation solution, such as the

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