CLINICAL TRIAL: UVA ISLET CELL TRANSPLANTATION IN PATIENTS WITH TYPE I DIABETES

这个子项目是许多利用 由NIH/NCRR资助的中心赠款提供的资源。子项目和 研究者（PI）可能从另一个NIH来源获得了主要资金， 因此可在其他CRISP条目中表示。所列机构为 研究中心，而研究中心不一定是研究者所在的机构。 胰岛细胞移植在动物模型中的成功已经在人类I型糖尿病人类受体中进行的实验过程中达到高潮。临床胰岛移植的结果一直是可变的，但最近大多数受体在移植后一年不接受胰岛素治疗。通过经皮将分离的胰岛细胞输注到肝脏中避免了手术并发症，这有望成为一种更安全的移植模式，并减少术后护理和住院治疗的需求。 最近，阿尔伯塔大学在使用新的免疫抑制药物组合时取得了成功，这在移植组中引起了新的热情。该程序被称为埃德蒙顿方案，已证明成功率提高，许多患者成功地保持了3年以上的胰岛素。 弗吉尼亚大学的胰岛移植方案将重点关注2组受者，均无低血糖意识：非尿毒症单独胰岛移植患者（ITA）和肾移植后胰岛移植同时服用免疫抑制剂（IAK）。 对于两组受者，我们假设使用连续葡萄糖监测技术密切监测胰岛功能将允许早期检测胰岛功能障碍和更正式的调查（OGTT，IVGTT），如果确定为异常，将允许进一步诊断评估供体特异性反应和可能的干预，如外源性胰岛素给药或增加更多的免疫抑制。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The success of pancreatic islet cell transplantation in animal models has culminated in the experimental procedure being performed in human type I diabetic human recipients. The outcome of clinical islet transplant has been variable, but more recently the majority of recipients are free from insulin therapy one year after transplantation. The avoidance of surgical complications through the percutaneous infusion of isolated islet cells into the liver promises a safer mode of transplantation and less need for post surgical care and hospitalization. The recent success of the University of Alberta when using new combinations of immunosuppressive drugs has led to new enthusiasm amongst transplant groups. This procedure, known as the Edmonton Protocol, has demonstrated improved success with a number of patients successfully remaining off insulin for over 3 years. The islet transplant protocol at the University of Virginia will focus on 2 groups of recipients, both with hypoglycemic unawareness: non-uremic islet transplant alone patients (ITA) and islet transplant after renal transplantation while taking immunosuppressants (IAK). For both groups of recipients, we hypothesize the close monitoring of islet function using continuous glucose monitoring techniques will allow early detection of islet dysfunction and more formal investigation (OGTT, IVGTT), which, if determined to be abnormal, will allow further diagnostic evaluation of donor specific reactivity and possible intervention such as exogenous insulin administration or the addition of more immunosuppression.