Goto T, Tanioka Y, Sakai T, Matsumoto I, Kakinoki K, Tanaka T, Li S, Yoshikawa T, Fujino Y, Suzuki Y, Kuroda Y
Division of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Transplant Proc. 2005 Oct;37(8):3430-2. doi: 10.1016/j.transproceed.2005.09.041.
Young donors, donors with low body mass index (BMI), and non-heart-beating (NHB) donors are considered nonideal for islet transplantation. In this report, we successfully used a pancreas from a young, low-BMI, NHB donor for islet transplantation.
The donor was a 15-year-old adolescent boy whose cause of death was rupture of a primary brain tumor. According to Japanese regulations, his pancreas was procured after cardiac arrest. Warm ischemic time was 3 minutes and cold ischemic time was 300 minutes. The pancreas was digested by the automated method of Ricordi, followed by purification using continuous Euro-Ficoll gradients on a Cobe 2991 device. The recipient was a 35-year-old woman with unstable type 1 diabetes mellitus. Her pretransplant C-peptide level was null. She suffered frequent hypoglycemic unawareness. Her pretransplant M value, which is a good marker for glucose instability, was 125. Islet yield was 252,816 IEQ. There were no signs of contamination. Viability of islets assessed by FDA/PI staining was 83%. Stimulation index was 2.7.
The patient received 5160 IEQ/kg of islets via the portal vein under local anesthesia. There were no transplant-related complications. Although she required minimal exogenous insulin, her C-peptide level increased to 0.7 ng/mL at postoperative day (POD) 14. Her M value at POD 15 to 19 decreased dramatically to 23.6, indicating good glycemic control. At 3 months posttransplant, episodes of hypoglycemia disappeared.
Although an additional transplant is mandatory to wean patients from insulin, this case shows the possibility of using marginal donors, such as a young, low-BMI, NHB donor, for pancreas islet transplantation.
年轻供体、低体重指数（BMI）供体以及非心脏跳动（NHB）供体被认为不适合用于胰岛移植。在本报告中，我们成功地将一位年轻、低BMI、NHB供体的胰腺用于胰岛移植。
供体是一名15岁的青少年男性，死因是原发性脑肿瘤破裂。根据日本法规，在心脏骤停后获取其胰腺。热缺血时间为3分钟，冷缺血时间为300分钟。胰腺采用Ricordi自动方法消化，随后在Cobe 2991设备上使用连续的欧洲菲可（Euro-Ficoll）梯度进行纯化。受体是一名35岁的1型糖尿病不稳定型女性。她移植前的C肽水平为零。她频繁发生低血糖无意识现象。她移植前的M值（是葡萄糖不稳定性的良好标志物）为125。胰岛产量为252,816胰岛当量（IEQ）。没有污染迹象。通过FDA/PI染色评估的胰岛活力为83%。刺激指数为2.7。
患者在局部麻醉下通过门静脉接受了5160 IEQ/kg的胰岛移植。没有与移植相关的并发症。尽管她仅需要极少的外源性胰岛素，但术后第14天她的C肽水平升至0.7 ng/mL。术后第15至19天她的M值大幅降至23.6，表明血糖控制良好。移植后3个月，低血糖发作消失。
尽管必须进行额外的移植以使患者停用胰岛素，但本病例表明使用边缘供体（如年轻、低BMI、NHB供体）进行胰岛移植是有可能的。
