SRS89 Patey Prize Entrant - The impact of time to death in circulatory death donors and pancreas islet isolation outcomes

Introduction Islet transplantation is an established treatment for a select cohort of patients with diabetes. Donation following circulatory death (DCD) entails varying agonal/ischemic times. We aimed to assess the impact of these time periods on the outcome of islet isolation. Methods Population cohort study of islet isolations from DCD pancreases (2009–2023). Regression models with restricted cubic splines (RCS) for non-linear modelling, evaluated associations between ischemic intervals and islet outcomes, adjusted for key factors. Results 153 pancreas isolations were included. Median islet yield was 235 000 IEQ (IQR: 138–347), with a median viability of 80.0% (IQR:75.0–85.0) and 50.3% met transplantation release criteria. Median time-to-death (TTD) was 14 min (IQR:10.5–18.5). No significant associations were observed between TTD, warm ischemia time or functional warm ischemia time and islet viability, yield or purity (P > 0.20 for all). RCS analyses also showed no significant non-linear effects (P > 0.10 for all). However, across all models pancreatectomy time consistently predicted lower islet viability (P = 0.009–0.012), highlighting the significance of rapid retrieval. Increasing cold ischemia time was associated with a lower chance of the islet isolation reaching overall release criteria. Paradoxically, those with very short CIT had significantly inferior islet viability. Conclusions Consistent with our recent work in whole organ pancreas transplantation, TTD does not impact on islet isolation outcomes and prolonged donor TTD should not be seen as a barrier to islet isolation. In contrast, prolonged pancreatectomy time was associated with inferior isolation outcomes, highlighting the importance of rapid retrieval.