In vivo pancreatic-specific hypothermia: retrograde ductal perfusion experimental studies

Abstract

Cellular damage caused by warm ischaemia is a well-recognized problem in all areas of transplantation.[1 and 2] These problems are particularly apparent in the living donor or autotransplantation situation, where conventional methods for cooling the organ in situ by vascular flushing with a cold preservation solution [3] cannot be utilized. In the case of living kidney donors, the most common scenario for living donors, the consistent and relatively simple vascular anatomy allows the organ to be fully mobilized on a vascular pedicle, thereby minimizing warm ischaemic time. [4] However, this is not always the situation for other organs (for example, total pancreatectomy for benign disease, usually chronic pancreatitis). The scarred and fibrotic nature of the diseased pancreas makes resection a lengthy procedure, and the complex arterial supply precludes the mobilization of the gland on a vascular pedicle. A combination of both these factors results in the resected pancreas being subjected to a considerable duration of warm ischaemia. This is obviously not important if the pancreas is simply being resected; however, if islet isolation and autotransplantation are being performed in conjunction with resection, the duration of warm ischaemia and the subsequent islet damage are vital factors in the success or failure of the islet autotransplant. This study investigated the feasibility of producing pancreatic-specific in vivo hypothermia by retrograde perfusion of the pancreatic duct with a cooled solution.