Markmann James F, Deng Shaoping, Huang Xiaolun, Desai Niraj M, Velidedeoglu Ergun H, Lui Chengyang, Frank Adam, Markmann Eileen, Palanjian Maral, Brayman Kenneth, Wolf Bryan, Bell Ewan, Vitamaniuk Marko, Doliba Nicolai, Matschinsky Franz, Barker Clyde F, Naji Ali
Department of Surgery, University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 4th Floor Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA.
Ann Surg. 2003 Jun;237(6):741-9; discussion 749-50. doi: 10.1097/01.SLA.0000072110.93780.52.
To restore islet function in patients whose labile diabetes subjected them to frequent dangerous episodes of hypoglycemic unawareness, and to determine whether multiple transplants are always required to achieve insulin independence.
The recent report by the Edmonton group documenting restoration of insulin independence by islet transplantation in seven consecutive patients with type 1 diabetes differed from previous worldwide experience of only sporadic success. In the Edmonton patients, the transplanted islet mass critical for success was approximately more than 9,000 IEq/kg of recipient body weight and required two or three separate transplants of islets isolated from two to four cadaveric donors. Whether the success of the Edmonton group can be recapitulated by others, and whether repeated transplants using multiple donors will be a universal requirement for success have not been reported.
The authors report their treatment with islet transplantation of nine patients whose labile type 1 diabetes was characterized by frequent episodes of dangerous hypoglycemia.
In each of the seven patients who have completed the treatment protocol (i.e., one or if necessary a second islet transplant), insulin independence has been achieved. In five of the seven patients only a single infusion of islets was required. To date, only one recipient has subsequently lost graft function, after an initially successful transplant. This patient suffered recurrent hyperglycemia 9 months after the transplant.
This report confirms the efficacy of the Edmonton immunosuppressive regimen and indicates that insulin independence can often be achieved by a single transplant of sufficient islet mass.
恢复不稳定型糖尿病患者的胰岛功能，这类患者常因低血糖无意识而经历频繁的危险发作，并确定是否总是需要多次移植才能实现胰岛素自主分泌。
埃德蒙顿研究小组最近的报告记录了7例1型糖尿病患者通过胰岛移植实现胰岛素自主分泌，这与此前全球仅偶有成功的经验不同。在埃德蒙顿的患者中，成功的关键移植胰岛量约超过9000 IEq/kg受体体重，且需要从2至4名尸体供体分离的胰岛进行两到三次单独移植。埃德蒙顿小组的成功是否能被其他人复制，以及使用多个供体进行重复移植是否是成功的普遍要求，此前尚无报道。
作者报告了他们对9例不稳定型1型糖尿病患者进行胰岛移植的治疗情况，这些患者常出现危险的低血糖发作。
在完成治疗方案的7例患者中（即进行一次或必要时进行第二次胰岛移植），均实现了胰岛素自主分泌。7例患者中有5例仅需单次输注胰岛。迄今为止，只有1例接受者在最初移植成功后失去了移植物功能。该患者在移植后9个月出现反复高血糖。
本报告证实了埃德蒙顿免疫抑制方案的疗效，并表明通过单次移植足够量的胰岛通常可以实现胰岛素自主分泌。
