Development of new immunosuppression by intra-portal administration of donor specific miss-match antigen in pancreas transplantation

供体术后2周出院，无任何手术并发症。受者的术后过程也平安无事。免疫抑制采用无类固醇方案，使用胸腺球蛋白、FK506和MMF，门静脉内输注供体特异性抗原^2。无出血及胰漏。移植后15天出院。免疫分析显示移植后第7天Th2型细胞因子白细胞介素10被激活（图1）。混合淋巴细胞反应显示移植后8个月供体特异性免疫抑制。她从低血糖症中恢复过来了。术后6个月，患者体重下降56kg， HbA1c降至5.1%。到目前为止还没有任何拒绝。日本LRPT首次成功实施生理性肠内引流和无类固醇治疗。肠内引流在尸体胰腺移植中明显增加。在活体部分胰腺移植中，肠内引流被认为是在精心的手术技术下进行生理性重建的一种选择。LRPT可能是预防1型糖尿病尸体胰腺移植并发症的有效治疗方法。我们已经报道了活体肝移植中供体特异性输注的门静脉内管理。在这项研究中，我们的经验表明，在LRPT中，如我们的活亲属肝移植，门内给药供体白细胞也可能作为无类固醇团的诱导治疗有效。

Donor discharged 2 weeks after surgery without any surgical complication. Recipient's postoperative course was also uneventful. Immunosuppresion was performed by steroid free regimen using thymoglobulin and FK506 and MMF with intraportal infusion of donor specific antigens^2. There were neither hemorrhage nor pancreatic leakage. She discharged 15 days after transplantation. Immunological analysis revealed of activation of interleukin 10 of Th2 type cytokine on day 7 after transplantation(Fig1). Mixed lymphocyte reaction demonstrated the donor specific immunosuppression at 8 month after transplantation. She released from hypoglycemia. Her body weight decreased by 56kg and HbA1c decreased to 5.1% for 6 months after the operation. There are no any rejection until now.The first case of both physiologic enteric drainage and steroid free regiment were successfully performed in LRPT in Japan. Enteric drainage has remarkably increased in cadaver pancreas transplantation. In living partial pancreas transplantation, the enteric drainage is considered to be one option as physiologic reconstruction under careful surgical technique. LRPT might be very useful therapy for type I diabetes mellitus for preventing diabetic complication with cadaver pancreas transplantation. We have already reported about the intraportal administration of donor specific transfusion in living related liver transplantation. In this study, it was demonstrated that the intraportal administration of donor leukocytes might be also effective as induction therapy for steroid free regiment in LRPT such as our experienced of living related liver transplantation.