Meloche R Mark
Department of Surgery, University of British Columbia, 5th Floor Diamond Centre, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
World J Gastroenterol. 2007 Dec 21;13(47):6347-55. doi: 10.3748/wjg.v13.i47.6347.
Transplantation of pancreatic tissue, as either the intact whole pancreas or isolated pancreatic islets has become a clinical option to be considered in the treatment of patients with type 1 insulin-dependant diabetes mellitus. A successful whole pancreas or islet transplant offers the advantages of attaining normal or near normal blood glucose control and normal hemoglobin A1c levels without the risks of severe hypoglycemia associate with intensive insulin therapy. Both forms of transplants are also effective at eliminating the occurrence of significant hypoglycemic events (even with only partial islet function evident). Whereas whole pancreas transplantation has also been shown to be very effective at maintaining a euglycemic state over a sustained period of time, thus providing an opportunity for a recipient to benefit from improvement of their blood glucose control, it is associated with a significant risk of surgical and post-operative complications. Islet transplantation is attractive as a less invasive alternative to whole pancreas transplant and offers the future promise of immunosuppression-free transplantation through pre-transplant culture. Islet transplantation however, may not always achieve the sustained level of tight glucose control necessary for reducing the risk of secondary diabetic complications and exposes the patient to the adverse effects of immunosuppression. Although recent advances have led to an increased rate of obtaining insulin-independence following islet transplantation, further developments are needed to improve the long-term viability and function of the graft to maintain improved glucose control over time.
胰腺组织移植,无论是完整的全胰腺还是分离的胰岛,都已成为治疗1型胰岛素依赖型糖尿病患者时可供考虑的一种临床选择。成功的全胰腺或胰岛移植具有以下优势:能够实现正常或接近正常的血糖控制以及正常的糖化血红蛋白水平,且不存在强化胰岛素治疗所带来的严重低血糖风险。两种移植方式在消除严重低血糖事件的发生方面也都很有效(即使仅表现出部分胰岛功能)。虽然全胰腺移植在维持较长时间的血糖正常状态方面也已被证明非常有效,从而为受体提供了从改善血糖控制中获益的机会,但它伴随着手术及术后并发症的重大风险。胰岛移植作为全胰腺移植的一种侵入性较小的替代方案很有吸引力,并且通过移植前培养有望实现无免疫抑制移植。然而,胰岛移植可能并不总能达到降低继发性糖尿病并发症风险所需的持续严格血糖控制水平,并且会使患者面临免疫抑制的不良影响。尽管最近的进展已使胰岛移植后实现胰岛素自主分泌的比率有所提高,但仍需要进一步发展以改善移植物的长期存活能力和功能,从而随着时间的推移维持更好的血糖控制。