Administrative and Bioinformatics Coordinating Center, Division of Information Sciences, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA.
Am J Transplant. 2010 Mar;10(3):646-56. doi: 10.1111/j.1600-6143.2009.02962.x. Epub 2010 Jan 5.
Islet transplantation is a promising therapy used to achieve glycometabolic control in a select subgroup of individuals with type I diabetes. However, features that characterize human islet isolation success prior to transplantation are not standardized and lack validation. We conducted a retrospective analysis of 806 isolation records from 14 pancreas-processing laboratories, considering variables from relevant studies in the last 15 years. The outcome was defined as post-purification islet equivalent count, dichotomized into yields > or =315 000 or < or =220 000. Univariate analysis showed that donor cause of death and use of hormonal medications negatively influenced outcome. Conversely, pancreata from heavier donors and those containing elevated levels of surface fat positively influence outcome, as did heavier pancreata and donors with normal amylase levels. Multivariable logistic regression analysis identified the positive impact on outcome of surgically intact pancreata and donors with normal liver function, and confirmed that younger donors, increased body mass index, shorter cold ischemia times, no administration of fluid/electrolyte medications, absence of organ edema, use of University of Wisconsin preservation solution and a fatty pancreas improves outcome. In conclusion, this multicenter analysis highlights the importance of carefully reviewing all donor, pancreas and processing parameters prior to isolation and transplantation.
胰岛移植是一种有前途的治疗方法，用于实现特定的 I 型糖尿病患者的血糖代谢控制。然而，在移植前用于描述胰岛分离成功的特征尚未标准化，也缺乏验证。我们对来自 14 个胰腺处理实验室的 806 个分离记录进行了回顾性分析，考虑了过去 15 年相关研究中的变量。结果定义为纯化后胰岛当量计数，分为产量>或=315 000 或<或=220 000。单因素分析显示，供体死亡原因和激素药物的使用对结果有负面影响。相反，来自较重供体的胰腺和含有较高表面脂肪水平的胰腺对结果有积极影响，较重的胰腺和淀粉酶水平正常的供体也是如此。多变量逻辑回归分析确定了手术完整的胰腺和肝功能正常的供体对结果的积极影响，并证实年轻的供体、较高的体重指数、较短的冷缺血时间、不给予液体/电解质药物、无器官水肿、使用威斯康星大学保存溶液和脂肪胰腺可以改善结果。总之，这项多中心分析强调了在分离和移植前仔细审查所有供体、胰腺和处理参数的重要性。
