Poster 12. Pancreas donation after euthanasia - a suitable islet source for transplantation?

Thursday 14 march 2019

13:03 - 13:06h

Categories: Klinisch, Postersessie

Parallel session: Postersessies 3 - Clinical

A. Steffen1, J.B. Doppenberg1, M.A.J. Hanegraaf1, D.J.C. Alders2, V.A.L. Huurman3, M.A. Engelse1, E.J.P. de Koning1

1Dept. of Internal Medicine, 2Dept. of Anesthesiology, 3Dept. of Surgery, Leiden University Medical Center, Leiden, The Netherlands.

Background: In the Netherlands organ donation after euthanasia (medically assisted cardiocirculatory death category 5 (DCD5)) is possible. The percentage of DCD5 out of the total number of organ donations is steadily increasing (0.3% in 2012 to 5% in 2017). DCD5 donor pancreata for islet transplantation would be useful in the context of organ shortage. Nonetheless, it is still unclear whether a DCD5 procedure, that entails neuromuscular blockade with nicotinic receptor antagonists, affects the number and function of isolated islets. The aim of this study was to evaluate the suitability of DCD5 organs for islet transplantation and to compare islet yield and function with organs procured during DCD awaiting cardiac arrest (DCD3), the most common controlled DCD procedure.

Methods: DCD5 organs (n=16) and DCD3 organs (n=48) were accepted for islet isolation. Donor and organ characteristics, islet isolation outcome and islet survival were analyzed. Additionally, islet function was determined using a dynamic glucose stimulation assay. Data are represented as mean ± SEM.

Results: DCD5 and DCD3 donors had a comparable age (52 ± 2.6 and 46 ± 1.6 resp (p=0.054), BMI (25 ± 1.3 and 26 ± 0.6, p=0.21) and pancreas weight (96 ± 4.5 and 112 ± 4.5 (p=0.062). There was no significant difference in islet yield (total IEQ DCD5: 368,000 ± 42,000, DCD3: 530,000 ± 82,000 (p=0.052)), IEQ/gram digested tissue (DCD5: 4626 ± 530, DCD3: 5500 ± 462 (p=0.313)) or islet survival (DCD5: 81 ± 6%, DCD3: 86 ± 4% (p=0.502)). Upon a glucose challenge DCD5 islets showed a significant lower insulin secretory response with reduced area-under-the curve for insulin (DCD5: 12 ± 2.2 and DCD3: 32 ± 3.7 (p=0.003)).

Conclusions: Islet yield and survival is comparable after isolation from DCD5 and DCD3 organs. Despite the lower insulin secretory response DCD5 organs are likely to be a suitable islet source for islet transplantation but clinical studies are needed.