Objective: In recent years, rates of pancreas transplantation have remained stagnant in part due to increasingly stringent donor criteria. Compared to other abdominal organs, the use of extended criteria grafts in pancreas transplantation, including donation after cardiac death (DCD) donors, remains limited. The purpose of this review is to highlight recent work in the field of pancreas and islet preservation.

Results: Emerging preclinical and clinical data support the use of machine perfusion, both normothermic and hypothermic, as a mechanism by which to assess graft viability in an ex-situ circulation system prior to transplantation. Similarly, as normothermic regional perfusion (NRP) gains popularity, it will have significant implications on the potential organ pool for pancreas transplantation. Finally, recent advancements in cryoprotective agent composition as well as cooling and rewarming technologies have great potential to facilitate subzero preservation of pancreata and islets for long-term storage.

Conclusions: Broad scaling of newer preservation techniques for pancreas and islet transplantation will require overcoming challenges, including optimizing protocols, ensuring cost-effectiveness, and translation of experimental techniques to the clinical setting. Nevertheless, these strategies for pancreas procurement and preservation may facilitate increased use of marginal grafts and increase the donor pool.