Influence of preservation time on outcome and metabolic function of bladder-drained pancreas transplants

The influence of cold storage preservation time on graft survival and metabolic function of pancreatic transplants was studied in 130 recipients of bladder-drained grafts (47 simultaneous with, 33 after, and 50 without a kidney transplant) between October 1, 1984 and May 1,1989. The recipients were divided into four groups according to the preservation time: < 6 hr (n = 11), 6-12 hr (n = 24), 12-24 hr (n = 75), and > 24 hr (n = 20). Twenty-six grafts were procured by other transplant teams and sent to us. Silica gel fractionated plasma was used for preservation in 104 cases and the University of Wisconsin solution in 25 (1 in the < 6 hr, 2 in the 6-12 hr, 16 in the 12-24 hr, and 6 in the > 24 hr groups). The technical failure rate at 1 month was 13% (17 grafts), 1 (9%) in the < 6 hr, 5 (21%) in the 6-12 hr, 9 (12%) in the 12-24 hr, and 2 (10%) in the > 24 hr groups. At 1 month, 107 (82%) of the grafts were functioning, 10 (91%) in the < 6 hr, 18 (75%) in the 6-12 hr, 62 (83%) in the 12-24 hr and 17 (85%) in the > 24 hr groups, the longest preserved for 30 hr. The respective 1-year graft survival rates were 51%, 50%, 57%, and 70%. Ninety patients (10 in the < 6 hr, 16 in the 6-12 hr, 51 in the 12-24 hr, and 13 in the > 24 hr groups) had metabolic studies between 2 and 6 weeks posttransplant. The results of 24-hour profiles (14 blood glucose determinations) were similar in each preservation time group; the means of the mean (±SD) profile glucose (mg/dl) values were 130±19, 126±31, 130±24, and 129±30, respectively (P>0.6). Mean plasma glucose levels at 2 hr during OGTT were 141±32, 145±43, 163±49, and 184±100 in the respective preservation groups (P>0.064). According to the National Diabetes s Data Group classification, 75% of recipients in the < 6 hr, 50% in the 6-12 hr, 44% in the 12-24 hr, and 33% hr in the > 24 hr groups had normal OGTT results. Al- . though the proportion with normal OGTT results decreased with increasing preservation time, the differ- P ences were not significant (P>0.3). The mean K values P during IVGTT were -1.37±0.35, -1.40±0.42, -1.38± 0.43, and —1.70±0.39% in the respective groups s (P>0.1). The mean 24-hr profile and 2-hr OGTT glucose v values were significantly lower (P<0.04) in normal con- C trols (n = 55) compared with all groups of recipients, <j but K values were similar. Graft exocrine function was t assessed by urine amylase activity (units/hr); mean values in the four preservation groups were 2736±1754, 5793±3899, 5284±3229, and 4374±2184 (P = NS). Comparisons of test results for recipients of grafts stored in SGF vs. UW showed no significant differences. We conclude that pancreatic transplants can be safely preserved up to 30 hr in either solution without any significant detrimental effect on graft function.