Lower beta cell yield from donor pancreases after controlled circulatory death prevented by shortening acirculatory warm ischemia time and by using IGL-1 cold preservation solution

Organs from donors after controlled circulatory death (DCD III) exhibit a higher risk for graft dysfunction due to an initial period of warm ischemia. This procurement condition can also affect the yield of beta cells in islet isolates from donor pancreases, and hence their use for transplantation. The present study uses data collected and generated by our Beta Cell Bank to compare the number of beta cells in isolates from DCD III (n = 141) with that from donors after brain death (DBD, n = 609), before and after culture, and examines the influence of donor and procurement variables. Beta cell number per DCD III-organ was significantly lower (58 x 10(6) versus 84 x 10(6) beta cells per DBD-organ; p < 0.001) but their purity (24% insulin positive cells) and insulin content (17 mu g / 10(6) beta cells in DCD III-organs versus 19 mu g / 10(6) beta cells in DBD-organs) were similar. Beta cell number correlated negatively with duration of acirculatory warm ischemia time above 10 min; for shorter acirculatory warm ischemia time, DCD III-organs did not exhibit a lower beta cell yield (74 x 10(6) beta cells). Use of Institut Georges Lopez-1 cold preservation solution instead of University of Wisconsin solution or histidine-tryptophan-ketoglutarate also protected against the loss in beta cell yield from DCD III-organs (86 x 10(6) for IGL-1 versus 54 x 10(6) and 65 x 10(6) beta cells respectively, p = 0.042). Multivariate analysis indicates that both limitation of acirculatory warm ischemia time and use of IGL-1 prevent the reduced beta cell yield in islet cell isolates from DCD III-organs.

Automated summary

Organs from donors after controlled circulatory death (DCD III) have lower beta cell numbers compared to those from brain death donors (DBD), but similar purity and insulin content. Shortening warm ischemia time and using specific preservation solutions can prevent the reduction in beta cell yield in DCD III organs.