Preservation of the porcine pancreas with HTK solution

Histidine Tryptophan Ketoglutarate (HTK) has been used for experimental and clinical cardiac, renal and liver transplantation in particular in the Eurotransplant setting. There is no data available for experimental or clinical pancreas transplantation. In the present study HTK was used for cold storage of pancreatic grafts and the results were compared to those obtained with UW solution. Methods: In a porcine model segmental pancreatic autografts were stored for 24, 48 or 72 hours in cold HTK or UW (University of Winsconsin) at 4 degrees C and then grafted into pancreatectomized diabetic recipients. Results: Landrace pigs (weighing 35-45 kg) were used for the study. Under general anesthesia a duodenum preserving total pancreatectomy was performed. The left hemipancreas was flushed through the aterial vascular pedicle with HTK or UW solution (50-100 cc, perfusion pressure of 60 cmH(2)O). Following storage of the graft for 24, 48 or 72 hours at 4 degrees C relaparotomy was performed and a heterotopic transplantation was performed to the iliac artery and vein. A total of 10/10 landrace pigs receiving a graft stored with HTK solution for 24 hours and 6/6 animals receiving a graft stored with UW solution for 24 hours were normoglycemic (i.e. bloodglucose < 150 mg/dl) and glucosuria was absent. Intravenous glucose tolerance tests (IVGTT) were comparable to 2 unoperated controls. Seven totally pancreatectomized not transplanted diabetic controls exhibited daily hyperglycemia, glucosuria (i.e. > 1000 mg/dl) and highly impaired IVGTTs (mean K-values -0.52 +/- 0.19 vs -1.25 +/- 0.46 for HTK, -1.30 +/- 0.81 for UW and -1.53 +/- 0.81 for controls, p vs diabetic < 0.01). The changes in wet weight between flushing and reperfusion were +2.22 +/- 2.84 g for HTK and -1.40 +/- 2.70 g for UW stored grafts (p = 0.034). Following 48 hours storage with HTK 4/17 grafts were functioning and 1/11 recipients of grafts stored with UW were normoglycemic. All grafts stored for 72 h in either HTK (n = 3) or UW (n = 3) uniformely failed to render the recipients normoglycemic. Conclusions: Preservation of segmental pancreatic autografts for 24 hours with HTK solution provides reliable graft function as does preservation with UW solution associated with an increase in wet weight following HTK preservation. Cold preservation with HTK and UW is feasable for 48 hours, however the successrate is equally reduced with HTK (23,5%) and UW (9%, p = ns) solution. 72 hours cold storage in either HTK or UW solution is resulting in uniform graft failure in this model.

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