Pancreas resuscitation for whole pancreas transplantation

Pancreas transplantation (PTx) is the only current treatment to replace completely the missing function of the pancreas in patients with diabetes. However, this is a high-risk procedure with complications that include vascular thrombosis and pancreatitis, both of which are clinical sequelae of ischemia-reperfusion (IR). The several factors that increase allograft susceptibility to IR include donor age, as well as warm and cold ischemia times. To improve the safety profile of PTx while also expanding organ utilization, future developments must minimize the occurrence and impact of ischemia-reperfusion injury (IRI) through improved preservation strategies and development of platforms to facilitate organ assessment and repair. These objectives are starting to be realized clinically in other solid organ groups through the emergence of machine perfusion and other novel technologies. Similar developments in the whole pancreas have not yet progressed to the same degree. A small number of experimental studies have investigated novel approaches to allograft preservation and these are summarized. Progress in this field requires understanding of the mechanisms that lead to ischemia-reperfusion injury, leading to innovative clinical trials. The field may then move toward a future where machine perfusion is used routinely as a means to facilitate viability assessment, as well as improve pancreas allograft preservation.