Improved human islet isolation outcome from marginal donors following addition of oxygenated perfluorocarbon to the cold-storage solution

TLDR

Only about 1,500 of roughly 6,000 donated pancreata are used for transplantation, largely because strict donor criteria and short cold‑ischemia times limit use, and prolonged ischemia damages islets that are highly oxygen‑dependent. This study aimed to improve marginal donor organ utilization by applying a two‑layer culture with oxygenated perfluorocarbon to the cold‑storage solution. The authors compared 15 pancreata preserved with a two‑layer UW medium plus oxygenated PFCs to 18 controls from donors over 50 years old, using the PFC layer to extend acceptable cold‑ischemia time. The PFC‑treated group produced twice as many islet equivalents and enabled clinical transplantation in 8 of 15 organs versus 2 of 18 in the control, indicating the method can reduce organ underuse.

Abstract

Last year, from the approximately 6,000 organ donors, only approximately 1,500 pancreata were used for clinical transplantation. Factors that contribute to this poor pancreas use include strict donor selection criteria and the requirement for short cold-ischemia time (CIT). Numerous pancreata have not been used because of long ischemia times postprocurement. Given the oxygen-rich environment of the islets in the native pancreas, it is conceivable that islets are highly susceptible to irreversible damage following prolonged ischemia. The use of continuously oxygenated perfluorohydrocarbons (PFCs), known for their high oxygen-solubility coefficients, in a two-layer culture with standard University of Wisconsin preservation media, has extended the acceptable range CIT, and, furthermore, there has been no evidence of adverse effects from PFCs on the outcome of transplanted cells, whereas they often enhance islet cell function. The purpose of this study was to use the two-layer culture method to improve donor-organ use from marginal donors. Fifteen organs were procured using the two-layer method, and 18 without using it, from donors greater than 50 years of age. Despite nonsignificant differences in age, weight of the donors, weight of the organ and CIT, the PFC group yielded an average of twofold more islet equivalents than those harvested from the control group. As a result, from the control group, only 2 of 18 organs were used for clinical islet transplantation, whereas 8 of 15 were used from the PFC group. To this end, the two-layer method may help clinicians overcome the problem of organ underuse.