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Islet transplantation for treatment of type-1 diabetes mellitus


Authors: František Saudek;  Peter Girman;  Jan Kříž;  Zuzana Berková;  Klára Zacharovová;  Tomáš Koblas;  Lenka Pektorová;  Ema Vávrová;  Martina Mindlová;  David Habart;  Jan Peregrin;  Květoslav Lipár;  Martin Oliverius;  Eva Dovolilová;  Evžena Číhalová;  Vít Bobek
Authors place of work: Institut klinické a experimentální medicíny Praha, Klinika diabetologie, Centrum diabetologie
Published in the journal: Čas. Lék. čes. 2011; 150: 49-55
Category: Original Article

Summary

Background:
Organ pancreas transplantation represents the only method enabling long-term normalization of glucose metabolism in type-1 diabetic subjects so far. Unfortunately, surgical complications of this kind of therapy are still frequent. As a safer alternative, transplantation of isolated pancreatic islets was introduced at the Institute for Clinical and Experimental Medicine as a clinical experiment in the year 2005.

Methods and results:
We isolated the islets from pancreases of cadaveric donors which did not fulfil criteria to perform organ pancreas transplantation. Altogether, 36 islet implantations were performed in 28 C-peptide negative subjects suffering from type-1 diabetes by August 2010. In 15 subjects (21 implantations) the main indication was extremely instable course of diabetes due to the hypoglycaemia unawareness syndrome. In 5 and 3 cases, combined islet and kidney and islet and liver transplants were performed, respectively. In addition, islet autotransplantation was performed in 5 subjects undergoing total pancreatectomy. No patient died during the study period. In all but 1 patient with primary islet afunction, islet transplantation led to a complete cure of the hypoglycemia unawareness syndrome. Out of 15 patients, 11 subjects in this group showed a significant C-peptide production (> 0.2 pmol/ml) after 1year. The mean insulin dose after allotransplantation decreased from 37 to 14 units per day and in 3 subjects, insulin therapy could be withdrawn. Serious technical complications occurred in 6 subjects, which only in 2 cases required surgical revision and did not cause long-term sequels.

Conclusions:
In comparison with organ pancreas transplantation, pancreatic islet transplantation represents a substantially safer method for restitution of endogenous insulin production. Though it eliminates serious hypoglycemic episodes in labile diabetes, complete insulin withdrawal is still often not possible. However, due to continuing progress in the laboratory techniques as well as in the transplant procedure itself, the results are steadily improving.

Key words:
type 1 diabetes mellitus, transplantation, islets of Langerhans, pancreas, insulin, immunosuppressive therapy, diabetic complications


Zdroje

1. Kopecký A. Dějiny cukrovky. Praha: Sdružení rodičů a přátel diabetických dětí v ČR 2000.

2. The DCCT Study Group. Adverse events and their association with treatment regimens in the diabetes control and complications trial. Diabetes Care 1995; 18(11): 1415–1427.

3. Kočandrle V, Bartoš V, Vaněk I, Neuwirtová K, Vondra K. Transplantation of the pancreas and kidney in a patient with diabetic microangiopathy. Čas Lék čes 1984; 123(5): 118–120.

4. Saudek F, Bouček P, Adamec M. Pancreas transplantation: who and when? Čas Lék čes 2001; 140(7): 195–199.

5. Adamec M, Saudek F. Transplantace sliivky břišní a diabetes mellitus. Praha: Karolinum, Galén 2005.

6. Troppmann C, Gruessner AC, Dunn DL, Sutherland DE, Gruessner RW. Surgical complications requiring early relaparotomy after pancreas transplantation: a multivariate risk factor and economic impact analysis of the cyclosporine era. Ann Surg 1998; 227(2): 255–268.

7. Saudek F. Léčba diabetu transplantací. Praha: Maxdorf 2003.

8. Harlan DM, Kenyon NS, Korsgren O, Roep BO. Current advances and travails in islet transplantation. Diabetes 2009; 58(10): 2175–2184.

9. Shapiro AM, Lakey JR, Ryan EA, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000; 343(4): 230–238.

10. Shapiro AM, Ricordi C, Hering BJ, et al. International trial of the Edmonton protocol for islet transplantation. N Engl J Med 2006; 355(13): 1318–1330.

11. Fiorina P, Shapiro AM, Ricordi C, Secchi A. The clinical impact of islet transplantation. Am J Transplant 2008; 8(10): 1990–1997.

12. Girman P, Berkova Z, Dobolilova E, Saudek F. How to use image analysis for islet counting. Rev Diabet Stud 2008; 5(1): 38–46.

13. Froud T, Ricordi C, Baidal DA, et al. Islet transplantation in type 1 diabetes mellitus using cultured islets and steroid-free immunosuppression: Miami experience. Am J Transplant 2005; 5(8): 2037–2046.

14. Saudek F, Jirák D, Girman P, Herynek V, Dezortová M, Kříž J, Peregrin J, Berková Z, Zacharovová K, Hájek M. Magnetic resonance imaging of pancreatic islets transplanted into the liver in humans. Transplantation 2010; 90: 1602–1606.

15. Villiger P, Ryan EA, Owen R, et al. Prevention of bleeding after islet transplantation: lessons learned from a multivariate analysis of 132 cases at a single institution. Am J Transplant 2005; 5(12): 2992–2998.

16. Mindlová M, Saudek F. Autonomní selhání způsobené recidivujícími hypoglykémiemi, jeho klinické hodnocení a terapie. Prakt Lék 2007; 87: 52–57.

17. Ryan EA, Paty BW, Senior PA, et al. Five-year follow-up after clinical islet transplantation. Diabetes 2005; 54(7): 2060–2069.

18. Hering BJ, Kandaswamy R, Harmon JV, et al. Transplantation of cultured islets from two-layer preserved pancreases in type 1 diabetes with anti-CD3 antibody. Am J Transplant 2004; 4(3): 390–401.

19. Blondet JJ, Carlson AM, Kobayashi T, et al. The role of total pancreatectomy and islet autotransplantation for chronic pancreatitis. Surg Clin North Am 2007; 87(6): 1477–1501.

20. Robertson RP. Islet transplantation a decade later and strategies for filling a half-full glass. Diabetes 2010; 59(6): 1285–1291.

Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental Hygienist

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Journal of Czech Physicians

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