Successful islet transplantation from a single pancreas harvested from a young, low-BMI, non-heart-beating cadaver
Successful islet transplantation from a single pancreas harvested from a young, low-BMI, non-heart-beating cadaver
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DOI：
10.1016/j.transproceed.2005.09.041
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发表时间：
2005-10-01
影响因子：
0.9
通讯作者：
Kuroda, Y
中科院分区：
文献类型：
--
作者：
Goto, T;Tanioka, Y;Kuroda, Y
背景年轻供体、低体重指数（BMI）供体和无心跳（NHB）供体被认为是胰岛移植的不理想供体。在本报告中，我们成功地使用了一个年轻的，低BMI，NHB供体的胰腺进行胰岛移植。捐赠者是一名15岁的青少年男孩，他的死因是原发性脑肿瘤破裂。根据日本的规定，他的胰腺是在心脏骤停后获得的。热缺血时间为3 min，冷缺血时间为300 min。通过Ricordi的自动化方法消化胰腺，然后在Cobe 2991装置上使用连续Euro-Ficoll梯度进行纯化。接受者是一名35岁女性，患有不稳定型1型糖尿病。她移植前的C肽水平为零她经常出现低血糖昏迷。她的移植前M值是125，这是葡萄糖不稳定的一个很好的标志。胰岛产量为252，816 IEQ。没有污染的迹象。通过FDA/PI染色评估的胰岛活力为83%。刺激指数为2.7。患者在局部麻醉下通过门静脉接受5160 IEQ/kg的胰岛。无移植相关并发症。尽管她需要最低限度的外源性胰岛素，但术后第14天（POD）她的C肽水平升高至0.7 ng/mL。她在术后第15天至第19天的M值急剧下降至23.6，表明血糖控制良好。移植后3个月，低血糖发作消失。尽管必须进行额外的移植才能使患者摆脱胰岛素，但该病例表明使用边缘供体（例如年轻、低BMI、NHB供体）进行胰岛移植的可能性。
Background. Young donors, donors with low body mass index (BMI), and non-heart-beating (NHB) donors are considered nonideal for islet transplantation. In this report, we successfully used a pancreas from a young, low-BMI, NHB donor for islet transplantation.Methods. The donor was a 15-year-old adolescent boy whose cause of death was rupture of a primary brain tumor. According to Japanese regulations, his pancreas was procured after cardiac arrest. Warm ischemic time was 3 minutes and cold ischemic time was 300 minutes. The pancreas was digested by the automated method of Ricordi, followed by purification using continuous Euro-Ficoll gradients on a Cobe 2991 device. The recipient was a 35-year-old woman with unstable type 1 diabetes mellitus. Her pretransplant C-peptide level was null. She suffered frequent hypoglycemic unawareness. Her pretransplant M value, which is a good marker for glucose instability, was 125. Islet yield was 252,816 IEQ. There were no signs of contamination. Viability of islets assessed by FDA/PI staining was 83%. Stimulation index was 2.7.Results. The patient received 5160 IEQ/kg of islets via the portal vein under local anesthesia. There were no transplant-related complications. Although she required minimal exogenous insulin, her C-peptide level increased to 0.7 ng/mL at postoperative day (POD) 14. Her M value at POD 15 to 19 decreased dramatically to 23.6, indicating good glycemic control. At 3 months posttransplant, episodes of hypoglycemia disappeared.Conclusions. Although an additional transplant is mandatory to wean patients from insulin, this case shows the possibility of using marginal donors, such as a young, low-BMI, NHB donor, for pancreas islet transplantation.