Clinical Islet Transplantation — Registry Report, Accomplishments in the past and Future Research Needs
Clinical Islet Transplantation — Registry Report, Accomplishments in the past and Future Research Needs
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临床胰岛移植——登记报告、过去的成就和未来的研究需求
作者：
B. Hering;Browatzki Cc;A. O. Schultz;R. Bretzel;K. Federlin
这篇综述提供了最近对1992年6月30日世界范围内临床成人胰岛移植的胰岛移植登记的分析结果。1893年12月12日至1992年6月30日期间，全球25家机构共进行了167例成人胰岛移植手术，其中北美9家机构进行了104例，欧洲15家机构进行了62例，其他地区1例。截至1992年6月30日，报告的成人胰岛移植后胰岛素独立的糖尿病患者总数为19例。按年代分析，移植后基础c肽水平呈阳性（≥1个月≥1 ng/mL）和胰岛素独立（bbb10 1周）的患者在1985-1989年（n = 35例）分别为20%和6%，在1990-1992年（n = 69例）分别为64%和20%，均有显著改善（p < 0.001和p < 0.05）。1990-1992年期间，单供胰腺组（n = 31例）移植后基础c肽水平阳性和胰岛素独立的患者比例分别为52%和13%，多供胰腺组（n = 36例）分别为75%和28%。储存≤6 h （n = 27）和bbb6≤12 h （n = 29）的胰岛移植物的胰岛功能率几乎相同，67%和72%的受体显示基础c肽水平阳性，30%和21%的受体胰岛素独立。如果胰岛储存超过12小时，没有单个患者表现出足以退出胰岛素的胰岛移植功能。六组的受体类别分别为IAK（肾后胰岛）、SIK（同时胰岛肾移植）、SIL（同时胰岛肝移植）、SIL（集丛手术后同时胰岛肝移植）、SIKL（同时胰岛肾肝移植）。与SIH-L（同时胰岛心肺移植）相比，移植后基础c肽水平阳性的患者分别为11例（58%）、17例（57%）、5例（83%）、8例（80%）、1例（50%）、0例（0%），胰岛素独立患者分别为4例（21%）、4例（13%）、0例（0%）、6例（60%）、0例（0%）、0例（0%）。比较两个最大的受体类别，即IAK和SIK，这些移植的结果没有明显差异。1990-1992年间移植的部位仅为肝脏、大网膜瓣和脾脏，受者总数分别为60例（90%）、4例（6%）和3例（4%）。在这三组中，基础c肽水平呈阳性的患者分别为38例（63%）、2例（50%）和1例（33%），胰岛素独立患者分别为13例（22%）、0例（0%）和0例（0%）。在绝大多数情况下，受体的选择不是基于预期的HLA供体/受体匹配。不同类型的HLA错配（即AB-、DR-、BDR-、abdr -错配）在结果上没有明显的趋势和差异。在1990-1992年期间，16例患者（24%）接受OKT3治疗，26例患者（39%）接受ALS、ALG或ATG治疗，25例患者（37%）未接受单克隆或多克隆t细胞抗体诱导免疫抑制。在上述三组中，基础c肽水平呈阳性的患者分别为12例（86%）、16例（62%）和15例（60%），胰岛素独立患者分别为2例（14%）、6例（23%）和6例（24%）。所有移植前c肽阴性的I型糖尿病患者成功胰岛素独立的摘要揭示了某些共同特征，例如每公斤体重移植≥8000个胰岛当量，移植胰岛纯度≥50%（除一例外），肝脏作为植入部位，OKT3或ALG/ ALS/ATG用于诱导免疫抑制（“最先进的”病例）。由于已明确证明胰岛移植可与其他器官移植联合成功进行，因此应更多地关注非尿毒症、非肾脏型1型糖尿病患者，自1990年以来未见一例此类患者的报道。这是真正的目标群体，可以从胰岛置换中获益最多。然而，如果能够开发出低风险但有效的方法来保护胰岛移植物免受终身免疫抑制的排斥反应，那么这种受体类别的胰岛移植将只有一个无可争议的适应症。
This review provides the results of a recent analysis of the Islet Transplant Registry on clinical adult islet transplants performed worldwide through June 30, 1992. Between December 12, 1893 and June 30, 1992, 167 adult islet transplants were performed at 25 institutions worldwide, including 104 at 9 institutions in North America, 62 at 15 institutions in Europe, and 1 elsewhere. The total number of diabetic patients reported to be insulin independent after adult islet allotransplantation through June 30,1992, was 19. In an analysis by era, the percentage of patients that showed positive basal C-peptide levels (i.e. ≥ 1 ng/mL at ≥ 1 mo) posttransplant, and that became insulin independent (>1 wk) in the 1985-1989 era (n = 35 cases) were 20% and 6%, and in the 1990-1992 era (n = 69 cases) were 64% and 20%, respectively, and thus have improved significantly (p < 0.001 and p < 0.05). For the 1990-1992 period, the percentage of patients who showed positive basal C-peptide levels post-transplant, and who became insulin independent in the single donor pancreas group (n = 31 cases) were 52% and 13%, and in the multiple donor pancreata group (n = 36 cases) were 75% and 28%, respectively. Islet graft function rates were nearly identical for grafts prepared from pancreata stored ≤6 h (n = 27) and >6 ≤ 12 h (n = 29), so that 67% and 72% showed positive basal C-peptide levels, and 30% and 21% of the recipients became insulin independent, respectively. No single patient showed islet graft function sufficient to allow withdrawal from insulin, if the pancreata have been stored for more than 12 h. In regard to recipient category for the six groups, namely IAK (islet after kidney), SIK (simultaneous islet kidney transplantation), SIL (simultaneous islet liver transplantation), SIL(C) (simultaneous islet liver transplantation after cluster operation), SIKL (simultaneous islet kidney liver transplantation), and SIH-L (simultaneous islet heart-lung transplantation), the number of patients who showed positive basal C-peptide levels post-transplant was 11 (58%), 17 (57%), 5 (83%), 8 (80%), 1 (50%), and 0 (0%), and the number of insulin independent patients was 4 (21%), 4 (13%), 0 (0%), 6 (60%), 0 (0%), and 0 (0%), respectively. Comparing the two largest recipient categories, namely IAK and SIK, no difference in the outcome of these transplants was apparent. The only sites of transplantation in the period between 1990-1992 were the liver, epiploic flap, and spleen, with the total number of recipients being 60 (90%), 4 (6%), and 3 (4%), respectively. For these three groups, the number of patients who showed positive basal C-peptide levels was 38 (63%), 2 (50%), and 1 (33%), and the number of insulin independent patients was 13 (22%), 0 (0%) and 0 (0%), respectively. In the overwhelming majority of cases, recipient selection was not based on prospective HLA donor/recipient matching. In different categories of HLA mismatching (i.e., AB-, DR-, BDR-, and ABDR-mismatch) no obvious tendency or difference in outcome could be demonstrated. In the 1990-1992 period, 16 patients (24%) received OKT3, 26 patients (39%) received ALS, ALG, or ATG, and 25 patients (37%) received neither monoclonal nor polyclonal T-cell antibodies for induction immunosuppression. For the three groups mentioned, the number of patients who showed positive basal C-peptide levels was 12 (86%), 16 (62%), and 15 (60%), and the number of insulin independent patients was 2 (14%), 6 (23%), and 6 (24%), respectively. A synopsis of all pretransplant C-peptide-negative Type I diabetic patients who succeeded in insulin independence revealed certain common characteristics, such as transplantations of ≥8000 islet equivalents per kilogram body weight, a purity of transplanted islets ≥ 50% (in all but one case), the liver as implantation site, and OKT3 or ALG/ ALS/ATG for induction immunosuppression (“state of the art” cases). Because it has been unequivocally proven that islet transplantation can be performed successfully in association with other organ transplants, more attention should be drawn to the nonuremic, nonkidney Type I diabetic patients, who have not been reported in a single case since 1990. This is the real target group, that could benefit most from islet replacement. However, islet transplantation in this recipient category will only have an undisputable indication, if low-risk, but effective methods other than life-long immunosuppression to protect the islet graft from rejection can be developed.
回顾世界胰腺和胰岛移植经验以及明尼苏达州相关捐献者和尸体捐献者腹膜内节段胰腺移植的结果。
影响因子：
0.9
作者：
Sutherland,DE;Goetz,FC;Najarian,JS
通讯作者：
Najarian,JS