Feasibility study of living donor islet transplantation using the two-layer method.

科比大学被指定为日本临床胰岛移植的认证机构之一。迄今为止，我们已从心脏骤停的尸体上获得8个胰腺，并将7个胰腺加工成胰岛。其中，3个分离株符合立即移植的标准。所有受试者均表现出较好的血糖控制，且外源性胰岛素用量较少。分离成功率达43%（3/7），与美国大批量胰岛移植中心报道的分离成功率相当。根据我们的临床经验，最大限度地提高胰岛产量和减少胰岛移植后即刻的丢失是成功的关键因素。因此，我们进行了重要的实验，并得到以下结果：实验1：在分离胰岛之前，采用双层法（TLM）保存胰腺，不仅提高了胰岛产量，而且改善了胰岛功能，几乎与新鲜分离的胰岛相当;实验2：采用TLM结合腺苷消化法消化后，组织ATP水平保持良好。可以回收更多数量的胰岛。实验3：80 mmHg减压控制胶原酶注射（RPCI）可持续提高大鼠胰岛产量和体内功能;实验4：腹腔内充氧PFC可改善门静脉内胰岛移植的效果

Kobe University is appointed as one of certified institutes for clinical islet transplantation in Japan. So far we have received 8 pancreases from heart arrested cadavers and processed 7 pancreases into islets. Of those, 3 isolates met the criteria for immediate transplantation. All receipents showed good glycemic control with less amount of exogenous insulin. Isolation success rate reached 43% (3/7) which is almost as same level as that reported from high volume centers in USA.Based on our clinical experience, maximizing islet yield and reducing islet loss immediately after implantation were the key factors for successful islet transplantation using live donor. Therefore, we performed important experiments and got following results.Exp 1: Two layer method (TLM) for pancreas preservation prior to islet isolation resulted in excellent islet function in addition to improved islet yield, which is almost comparable to freshly isolated islets.Exp 2: Tissue ATP levels after digestion were well maintained using TLM with adenosine digestion method. Greater numbers of islets could be retrieved. The new method was at least equivalent to islet function isolated by conventional method.Exp 3: Reduced-pressure controlled collagenase injection (RPCI) at 80 mmHg could contribute to consistently high islet yield and in vivo function in a rat model.Exp 4: intraperitoneal oxygenated PFC improves the outcome of intraportal islet transplantation