Successful islet transplantation from nonheartbeating donor pancreata using modified Ricordi islet isolation method
Successful islet transplantation from nonheartbeating donor pancreata using modified Ricordi islet isolation method
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DOI：
10.1097/01.tp.0000231710.37981.64
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发表时间：
2006-08-27
期刊：
影响因子：
6.2
通讯作者：
Tanaka, Koichi
中科院分区：
文献类型：
--
作者：
Matsumoto, Shinichi;Okitsu, Teru;Tanaka, Koichi
背景资料。目前胰岛移植的成功已导致供体短缺，需要边缘供体利用来缓解这一短缺。本研究旨在提高非心跳供体(NHBD)胰岛移植的疗效。首先，我们利用猪胰腺组织实施了几种策略，并将其应用于人胰腺组织。这些策略包括胰酶抑制剂用于胰管保护，ET-京都液用于胰腺保存，碘化醇用于胰岛纯化。这些策略显著提高了猪胰岛和人类胰岛的分离效率。平均获得399,469+/-36,411个IE人胰岛(n=13)。所有胰岛标本均符合移植标准，13例中有11例(85%)在日本首次移植给6例I型糖尿病患者。所有的胰岛都开始分泌胰岛素，所有患者的血糖控制都较好，没有低血糖意识丧失。6位受者的平均糖化血红蛋白水平从移植时的7.5+/-0.4%显著提高到目前的5.1+/-0.2%(P<；0.0003)。6名受者的平均胰岛素量从移植时的49.2+/-33单位显著减少到11+/-4.4单位(P<；0.0005)，6名患者中有5名患者的胰岛素剂量减少到一半以下。第一例患者现在无胰岛素，这在日本是第一例。这表明，我们目前的方案使得使用NHBD有效地将胰岛移植到I型糖尿病患者中是可行的。
Background. Current success of islet transplantation has led to donor shortage and the need for marginal donor utilization to alleviate this shortage. The goal of this study was to improve the efficacy of islet transplantation using nonheartbeating donors (NHBDs).Methods. First, we used porcine pancreata for the implementation of several strategies and applied to human pancreata. These strategies included ductal injection with trypsin inhibitor for protection of pancreatic ducts, ET-Kyoto solution for pancreas preservation, and Iodixanol for islet purification.Results. These strategies significantly improved both porcine and human islet isolation efficacy. Average 399,469 +/- 36,411 IE human islets were obtained from NHBDs (n = 13). All islet preparations met transplantation criteria and 11 out of 13 cases (85%) were transplanted into six type I diabetic patients for the first time in Japan. All islets started to secrete insulin and all patients showed better blood glucose control without hypoglycemic loss of consciousness. The average HbA1c levels of the six recipients significantly improved from 7.5 +/- 0.4% at transplant to 5.1 +/- 0.2% currently (P < 0.0003). The average insulin amounts of the six recipients significantly reduced from 49.2 +/- 33 units at transplant to 11 +/- 4.4 units (P < 0.0005) and five out of six patients reduced to less than half dose. The first patient is now insulin free, the first such case in Japan.Conclusion. This demonstrates that our current protocol makes it feasible to use NHBDs for islet transplant into type I diabetic patients efficiently.