CORRELATION BETWEEN HIGH ADENOSINE-TRIPHOSPHATE TISSUE CONCENTRATION AND GOOD POSTTRANSPLANT OUTCOME FOR THE CANINE PANCREAS GRAFT AFTER PRESERVATION BY THE 2-LAYER COLD-STORAGE METHOD

Assessment of viability of a pancreas graft during preservation is very important to avoid transplantation of a nonfunctioning allograft. In the present report the correlation between adenosine triphosphate tissue concentration at the end of cold preservation by the two-layer method and viability of a canine pancreas graft following transplantation was studied. After preservation by an original two-layer (Euro-Collins' solution/perfluorochemical) method (group 1) and a modified two-layer (University of Wisconsin solution/PFC) method (group 2) for 24, 48, 72, 96, and 120 hr (subgroups A, B, C, D, and E), the tissue concentration of ATP was determined using high-performance liquid chromatography, and the viability of the pancreas graft was tested in the canine model of segmental pancreas autotransplantation. Maintenance of normoglycemia for at least five days after transplantation was considered to indicate a viable pancreas graft. In group 1, functional success rates were A:5/5, (100%), B:4/4 (100%), C:4/4, (100%), and D:0/4 (0%), respectively. The ATP tissue concentrations were 7.47 +/- 0.47 (n = 5), 7.91 +/- 1.21 (n = 4), 8.29 +/- 0.21 (n = 4), and 4.94 +/- 1.11 (n = 4)-mu-mol/g dry weight in groups 1A, 1B, 1C, and 1D, respectively. There was a statistically significant difference between viable groups (groups 1A, 1B, and 1C, 7.86 +/- 0.77-mu-mol/g dry weight [n = 13]) and the nonviable group (group D, 4.94 +/- 1.11-mu-mol/g dry weight (n = 4) (P < 0.01). On the other hand, the functional success rates were 3/3 (100%), 3/3 (100%), 3/3 (100%), 5/7 (71%), and 0/3 (0%) in groups 2A, 2B, 2C, 2D, and 2E, respectively. Two of seven dogs died of causes related to the grafts (pancreatitis and thrombosis). The ATP tissue concentrations were 8.53 +/- 1.45 (n = 3), 9.64 +/- 1.77 (n = 3), 13.81 +/- 2.09 (n = 3), and 12.49 +/- 2.52 (n = 5)-mu-mol/g dry weight in groups 2A, 2B, and 2C and in viable grafts in group 2D, respectively, but the ATP tissue concentration of non-viable grafts in group 2D and group E were 3.51 +/- 0.81 (n = 2) and 3.98 +/- 1.34 (n = 3)-mu-mol/g dry weight, respectively. There was a statistically significant difference between viable groups (groups 2A, 2B, 2C and viable grafts in group 2D, 11.03 +/- 2.72-mu-mol/g dry weight [n = 14]) and nonviable groups (group E and nonviable grafts in group 2D, 3.79 +/- 1.06-mu-mol/g dry weight [n = 5]) (P < 0.01). On the other hand, based on analysis of individual ATP for each graft, there was no overlap between the lowest ATP (6.3-mu-mol/g dry weight) in the viable group and the highest ATP (6.1-mu-mol/g dry weight) in the nonviable group. If an ATP concentration of 6.2-mu-mol/g dry weight was determined as a critical value for doing the transplant, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 100%, 100%, and 100%, respectively. This study clearly demonstrates that the tissue level of ATP at the end of cold preservation by the two-layer method will predict the viability of the pancreas graft following transplantation.