Extending normothermic regional perfusion to pancreas recovery for clinical islet transplantation

Normothermic regional perfusion (NRP) is a strategy to improve organ quality in donation after circulatory death by restoring near-physiologic perfusion after circulatory arrest. Although its benefits are established in liver and kidney transplantation, its application to pancreas recovery and clinical islet transplantation is limited. Given the pancreas sensitivity to warm ischemia and the limited functional reserve inherent to islet transplantation, NRP may offer advantages over conventional cold recovery. We report our initial experience utilizing NRP for pancreas recovery in islet transplantation. Islet isolation yielded a high islet mass with excellent viability despite low donor body mass index, a factor traditionally associated with poor yield. Transplantation resulted in rapid improvement in glycemic control, reduced insulin requirements, resolution of hypoglycemia and favourable early graft function. This experience supports further evaluation of NRP to expand pancreas grafts utilization from donation after circulatory arrest and improve islet transplant outcomes.