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Introduction Transplantation of the islets of Langerhans is a well-known treatment for type 1 diabetes. Because of the high susceptibility of islets to hypoxic damage, the traditional method of organ preservation (cold storage) is not sufficient to completely prevent ischemic damage. Due to the impaired quantity and quality of the islets isolated from a single donor pancreas, it often requires two or three donor pancreases to sufficiently treat one patient. For kidneys and livers, the use of hypothermic machine perfusion (HMP) has already demonstrated to have beneficial effects on ischemic damage. Therefore, with our study we aim towards the development of a system for HMP of the human pancreas to ensure a better preservation of islets of Langerhans. 

Methods For optimal perfusion of the pancreas, a dual arterial perfusion system was developed. Six human donor pancreases (3 from DBD donors, 3 from DCD donors) that could not be used for pancreas or islet transplantation were perfused. Pancreases were perfused for six hours with oxygenated Belzer-Machine Perfusion solution via the splenic and superior mesenteric artery separately. Perfusion fluid was supplemented with a fluorescent dye. Tissue samples of pre- and post-perfused pancreases were taken for histological analysis and ATP-content. Perfusate samples were taken every hour to analyse amylase, lipase and LDH levels. 

Results There was a uniform fluorescent staining in the tissue samples demonstrating adequate perfusion of the entire pancreas. After perfusion, the architecture of the pancreatic tissue was intact with only minor signs of edema. No signs of apoptosis or inflammation were observed. ATP-content in the tissue increased significantly after perfusion (p<0,01). Noteworthy, ATP-levels in DBD pancreases before HMP were higher and showed a stronger increase after HMP compared to those observed in DCD pancreases. Analysis of the perfusate showed an increase in amylase, lipase and LDH levels during HMP, likely due to the washout of these enzymes. 

Conclusion In this study, we developed a system for HMP of the human pancreas. With our system it was feasible to realize an uniform perfusion of the pancreas, whereby integrity of the pancreatic tissue was preserved. ATP-content increased significantly after six hours of oxygenated HMP. In the near future, the effect of HMP on the quantity and quality of isolated islets of Langerhans will be examined.