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

神户大学被指定为日本临床胰岛移植认证机构之一。到目前为止，我们已经收到了8个来自心脏的胰腺，截获了身体，并将7个胰腺加工成胰岛。其中3株符合即刻移植标准。所有受试者血糖控制良好，外源性胰岛素用量较少。分离成功率达43%(3/7)，几乎与美国大容量中心的分离成功率相当。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植入后即刻的损失是活体胰岛移植成功的关键因素。因此，我们进行了一些重要的实验，并获得了以下结果。实验1：胰岛分离前的两层法(TLM)保存胰岛功能良好，胰岛产量几乎与新鲜分离的胰岛相当。实验2：用两层法结合腺苷消化法可以很好地维持消化后组织中的ATP水平。可以检索到更多数量的小岛。新方法至少相当于传统方法分离的胰岛功能。实验3：80 mmHg的降压控制胶原酶注射(RPCI)可以在大鼠模型中持续提高胰岛产量和体内功能。实验4：腹膜腔内充氧PFC改善门脉内胰岛移植的结果

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