Pancreatic Temperature During Transport for Transplantation: A Preclinical Study
Keywords:
Pancreas, Pancreas Transplant, Organ Transplant, Logistics, Cold IschemiaAbstract
Objectives: To compare the viability of porcine pancreases transported under static cold conditions using two transport models. Methods: A prospective preclinical case-control study with an adapted design, conducted on Landrace pig organs. Data were collected from three variables: temperature, macroscopic assessment, and histology. The variables were compared using two packaging models: the experimental model, Autonomous and Intelligent Packaging for Cold Chain in Healthcare Systems (Embalagem Autônoma e Inteligente para Cadeia Fria de Sistemas de Saúde [EMAIS-SR]), and the control, a conventional thermal container widely used and filled with ice. Three thermometers were used for temperature measurements: two for internal temperature and one for surface temperature. The macroscopic evaluation analyzed color, tissue integrity, consistency, and the presence of lesions, edema, or hematomas in the organ. For histology, the samples were fixed and stained with hematoxylin-eosin, which allows visualization of tissue morphology under light microscopy, followed by immunohistochemical analysis. Results: Ten experimental surgeries were performed: six pancreases were stored under static cold conditions and transported in the active-cooling container, while four were transported in the conventional ice-filled container. Among all cases, only one pancreas had an exit temperature higher (12.1 °C) than the recommended maximum of 8 °C. However, in the macroscopic evaluation, the organ with the higher exit temperature received a better evaluation, while the others maintained a qualitative macroscopic evaluation. In histological analysis, on average, pancreases transported in the active-cooling container demonstrated better tissue quality by presenting more preserved cellular structures. Conclusion: The preclinical experimental model demonstrated that, although the organ was kept within the recommended temperature range, organs maintained in the technological solution EMAIS-SR, which does not use ice, were better preserved. Furthermore, the only case in which temperature exceeded the recommended limit, that is, in which the organ warmed after packaging, occurred in the traditional ice-filled container. The research encourages the development of new and more robust studies on clinical decisions regarding safe thermal limits and best practices for transporting pancreases intended for transplantation.
Downloads
References
1. American Diabetes Association. Standards of medical care in diabetes – 2021. Diabetes Care, 2021 44 (Suppl 1): S1-S232. https://doi.org/10.2337/dc11-S011
2. Beringer K, Brethauer SA. Pancreas transplantation: indications and outcomes. J Diabetes Sci Technol, 2015; 9 (3): 563-72. https://doi.org/10.1016/j.suc.2018.09.007
3. Mei S, Huang Z, Dong Y, Chen Z, Xiang J, Zhou J, et al. Pancreas preservation time as a predictor of prolonged hospital stay after pancreas transplantation. J Int Med Res, 2021; 49 (2). https://doi.org/10.1177/0300060520987059
4. Roza BA, Schuantes-Paim SM, Leite R, Carbonel AF, Taha MO, David AI, et al. Safe transport of organs and tissues for transplants: technological innovation product validation method. Rev Assoc Med Bras, 2023; 69 (6): e20221537. https://doi.org/10.1590/1806-9282.20221537
5. Schuantes-Paim SM, Leite RF, Gonçalves VAC, Carbonel AA, Teraoka EC, Coutinho GMM, et al. Static cold package for transporting organs for transplants: validation method and pilot test. Sao Paulo Med J, 2025; 143 (6): e20252930. https://doi.org/10.1590/1516-3180.2025.2930.29042025
6. Kulu Y, Gollapudi N, de Klerk M, Ucar A, Furtado M, Kitzmiller J, et al. Expanding pancreas donor pool by evaluation of unallocated organs after brain death. Study protocol clinical trial (SPIRIT Compliant). Medicine, 2020; 99 (10). https://doi.org/10.1097/MD.0000000000019335
7. Whaley D, Damyar K, Witek RP, Mendoza A, Alexander M, Lakey JR. Cryopreservation: an overview of principles and cellspecific considerations. Cell Transplant, 2021; 30. https://doi.org/10.1177/0963689721999617
8. Prudhomme T, Mulvey JF, Young LAJ, Mesnard B, Lo Faro ML, Ogbemudia AE, et al. Ischemia-reperfusion injuries assessment during pancreas preservation. Int J Mol Sci, 2021; 22 (10): 5172. https://doi.org/10.3390/ijms22105172
9. Mazilescu LI, Parmentier C, Kalimuthu SN, Ganesh S, Kawamura M, Goto T, et al. Normothermic ex situ pancreas perfusion for the preservation of porcine pancreas grafts. Am J Transplant, 2022; 22 (5): 1339-49. https://doi.org/10.1111/ajt.17019
10. Kuipers TGJ, Hellegering J, El Moumni M, Krikke C, Haveman JW, Berger SP, et al. Kidney temperature course during living organ procurement and transplantation. Transpl Int, 2017; 30: 162-9. https://doi.org/10.1111/tri.12892
11. Lima AC, Alves JCR, Borga AL, Ocampos HBL, Deboni LM, Guterres JCP, et al. Análise da temperatura durante o armazenamento e o período de isquemia morna do enxerto em transplantes renais. Braz J Transplant, 2023; 26: e0423. https://doi.org/10.53855/bjt.v26i1.482_PORT
12. Abdelnour-Berchtold E, Ali A, Baciu C, Beroncal EL, Wang A, Hough O, et al. Evaluation of 10 °C as the optimal storage temperature for aspiration-injured donor lungs in a large animal transplant model. J Heart Lung Transplant, 2022; 41(12): 1679-88. https://doi.org/10.1016/j.healun.2022.08.025
13. Ali A, HoetzeneckerK, de la Cruz JLCC, Schwarz S, Barturen MG, Tomlinson G, et al. Extension of cold static donor lung preservation at 10 °C. NEJM Evidence, 2023; 2 (6): EVIDoa2300008. https://doi.org/10.1056/EVIDoa2300008
14. Longnecker DS. Anatomy and histology of the pancreas. Pancreapedia: Exocrine Pancreas Knowl Base. 2021;1.0. [Access on 23 Feb 2026]. Available at: https://pancreapedia.org/sites/default/files/Anatomy-And-Histology-of-the-Pancreas-Version-2.pdf
15. Haupt Y, Maya R, Kazaz A, Oren M. Mdm2 promotes the rapid degradation of p53. Nature, 1997; 387(6630): 296-9. https://doi.org/10.1038/387296a0
16. Vousden KH, Lane DP. p53 in health and disease. Nat Rev Mol Cell Biol, 2007; 8 (4): 275-83. https://doi.org/10.1038/nrm2147
17. Kruse JP, Gu W. Modes of p53 regulation. Cell, 2009; 137 (4): 609-22. https://doi.org/10.1016/j.cell.2009.04.050
18. Aubrey BJ, Strasser A, Kelly GL. Tumor-suppressor functions of the TP53 pathway. Cold Spring Harb Perspect Med, 2016; 6 (5): a026062. https://doi.org/10.1101/cshperspect.a026062
19. Levine AJ. p53: 800 million years of evolution and 40 years of discovery. Nat Rev Cancer, 2020; 20 (8): 471-80. https://doi.org/10.1038/s41568-020-0262-1
20. Korsmeyer SJ, Shutter JR, Veis DJ, Merry DE, Oltavai ZN. Bcl-2/Bax: a rheostat that regulates cell death. Semin Cancer Biol. 1993 [Access on 23 Feb 2026]; 4 (6): 327-32. Available at: https://europepmc.org/article/med/8142617
21. Kale J, Osterlund E, Andrews D. BCL-2 family proteins: changing partners in the dance towards death. Cell Death Differ, 2018; 25: 65-80. https://doi.org/10.1038/cdd.2017.186
22. Botrus G, Miller RM, Uson Junior PLS, Kannan G, Han H, Von Hoff DD. Increasing stress to induce apoptosis in pancreatic cancer via the unfolded protein response (UPR). Int J Mol Sci, 2022; 24 (1): 577. https://doi.org/10.3390/ijms24010577
23. Bancroft JD, Gamble M. Theory and practice of histological techniques. 7ª. ed. Philadelphia: Elsevier, 2013.
24. Ramos-Vara JA. Technical aspects of immunohistochemistry. Vet Pathol, 2005; 42 (4): 405-26. https://doi.org/10.1354/vp.42-4-405
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Sibele Maria Schuantes Paim, Victor Arayama Cruz, Karoline Sabrina de Carvalho Gomes, Julia Karini da Silva Araujo, Graciana Maria de Moraes Coutinho, Eliana Cavalari Teraoka, Renata Fabiana Leite, Vanessa Ayres Gonçalves, Adriana Aparecida Carbonel, Manuel de Jesus Simões, José Homero Soares, Murched Omar Taha, André Ibrahim David, Janine Schirmer, Bartira de Aguiar Roza
This work is licensed under a Creative Commons Attribution 4.0 International License.
