Lehmann R, Spinas G A, Moritz W, Weber M
University Hospital Zurich, Islet Transplant Program, Zurich, Switzerland.
Am J Transplant. 2008 Jun;8(6):1096-100. doi: 10.1111/j.1600-6143.2008.02214.x. Epub 2008 Apr 29.
The enthusiasm regarding clinical islet transplantation has been dampened by the long-term results. Concerns about the associated risks of life-long immunosuppression and the striking imbalance between potential recipients and available donor pancreata warrant changes in some of the current goals. Islet transplantation will never be a cure of type 1 diabetes in the majority of patients with no secondary complications, but is a valid option for a limited number of patients with brittle diabetes waiting for an organ or after organ transplantation. Furthermore, insulin independence should not be the main goal of islet transplantation, but avoidance of severe hypoglycemia and good glycemic control, which can be achieved with a relatively small functional beta-cell mass. Therefore, initially one islet infusion is sufficient. Retransplantation at a later time point remains an option, if glucose control deteriorates. Efforts to improve islet transplantation should no longer focus on islet isolation and immunosuppression, but rather on the low posttransplant survival rate of islets caused by activation of the coagulation pathway and the limited oxygen delivery to the islets. Transplantation of smaller islets be it naturally small or size tailored reaggregated islets has the potential to facilitate these processes.
长期结果削弱了人们对临床胰岛移植的热情。对终身免疫抑制相关风险的担忧以及潜在受者与可用供体胰腺之间的显著失衡，使得当前的一些目标需要做出改变。胰岛移植永远无法治愈大多数无继发并发症的1型糖尿病患者，但对于少数脆性糖尿病患者，在等待器官移植或器官移植后，它是一种有效的选择。此外，胰岛素非依赖不应是胰岛移植的主要目标，而应是避免严重低血糖和实现良好的血糖控制，这可以通过相对较小的功能性β细胞量来实现。因此，最初一次胰岛输注就足够了。如果血糖控制恶化，后期再移植仍是一种选择。改善胰岛移植的努力不应再集中在胰岛分离和免疫抑制上，而应关注凝血途径激活导致的胰岛移植后低存活率以及胰岛的有限氧输送。移植较小的胰岛，无论是天然较小的胰岛还是经过尺寸调整重新聚集的胰岛，都有可能促进这些过程。
