Islet Transplantation Using Donors After Cardiac Death: Report of the Japan Islet Transplantation Registry
Islet Transplantation Using Donors After Cardiac Death: Report of the Japan Islet Transplantation Registry
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DOI：
10.1097/tp.0b013e3181ecb044
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发表时间：
2010-10-15
期刊：
影响因子：
6.2
通讯作者：
Teraoka, Satoshi
中科院分区：
文献类型：
--
作者：
Saito, Takuro;Gotoh, Mitsukazu;Teraoka, Satoshi
背景本报告总结了2004年至2007年期间日本胰岛移植登记处报告的心源性死亡（DCD）后采用供体进行胰岛移植的结果。对18例胰岛素依赖型糖尿病患者（包括2例既往接受过肾移植的患者）的34例移植进行了65次胰岛分离。除1例（64/65）供体在收获时为DCD外，其余均为DCD。影响胰岛释放标准的因素包括供者低血压持续时间、冷缺血时间和京都保存液的使用。多元分析选择使用京都解决方案作为最重要的。在18名受体中，8名、4名和6名受体分别接受了1次、2次和3次胰岛输注。总移植物存活率定义为C肽水平大于或等于0.3 ng/mL，在1年、2年和3年分别为76.5%、47.1%和33.6%，而多次移植后相应的移植物存活率分别为100%、80.0%和57.1%。所有受试者均未发生严重低血糖，而3名受试者在14、79和215天内实现了胰岛素非依赖性。所有患者的HbA 1c水平和外源性胰岛素需求均显著改善。采用DCD的胰岛移植可以改善严重的低血糖发作，显著改善HbA 1c水平，维持显著水平的C肽，并在多次移植后实现胰岛素依赖性。因此，如果在严格的释放标准下使用，DCD可以成为胰岛移植的重要资源，并用于多次移植，特别是在心脏跳动供体不容易获得的国家。
Background. This report summarizes outcomes of islet transplantation employing donors after cardiac death (DCD) between 2004 and 2007 as reported to the Japan Islet Transplantation Registry.Method. Sixty-five islet isolations were performed for 34 transplantations in 18 patients with insulin-dependent diabetes mellitus, including two patients who had prior kidney transplantation. All but one donor (64/65) was DCD at the time of harvesting.Results. Factors influencing criteria for islet release included duration of low blood pressure of the donor, cold ischemic time, and usage of Kyoto solution for preservation. Multivariate analysis selected usage of Kyoto solution as most important. Of the 18 recipients, 8, 4, and 6 recipients received 1, 2, and 3 islet infusions, respectively. Overall graft survival defined as C-peptide level more than or equal to 0.3 ng/mL was 76.5%, 47.1%, and 33.6% at 1, 2, and 3 years, respectively, whereas corresponding graft survival after multiple transplantations was 100%, 80.0%, and 57.1%, respectively. All recipients remained free of severe hypoglycemia while three achieved insulin independence for 14, 79, and 215 days. HbA1c levels and requirement of exogenous insulin were significantly improved in all patients.Conclusion. Islet transplantation employing DCD can ameliorate severe hypoglycemic episodes, significantly improve HbA1c levels, sustain significant levels of C-peptide, and achieve insulin independence after multiple transplantations. Thus, DCD can be an important resource for islet transplantation if used under strict releasing criteria and in multiple transplantations, particularly in countries where heart-beating donors are not readily available.