1 Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada. 2 Division of Clinical Immunology, Department of Oncology, Radiology and Clinical Immunology, The Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
Transplantation. 2010 Feb 27;89(4):465-71. doi: 10.1097/TP.0b013e3181c478fd.
Successful islet transplantation can result in insulin independence in many patients with type 1 diabetes mellitus, but it often requires more than one islet infusion. The ability to achieve insulin independence with a single donor is an important goal in clinical islet transplantation due to the limited organ supply.
We examined factors that may be associated with insulin independence after islet transplantation with islets from a single donor, using univariate and multivariate analysis.
Thirteen of 85 (15.3%) achieved insulin independence after single-donor islet transplantation. Using multivariate analysis, only the use of insulin and heparin infusions peritransplant was a significant factor associated with insulin independence, with an adjusted odds ratio of 8.6 (95% confidence interval 2.0-37.0). Patients who had received insulin and heparin infusions peritransplant had greater indices of islet engraftment and a greater reduction in insulin use (80.1% + or - 4.3% vs. 54.2% + or - 2.8%, P<0.001) even if insulin independence was not achieved.
Peritransplant intensive insulin and heparin enhances islet transplantation outcomes likely related in part to mitigation of the effects of the instant blood-mediated inflammatory reaction, combined with islet rest and avoidance of inflammation. It would be important to further investigate the effects of peritransplant insulin and heparin infusions on islet engraftment.
成功的胰岛移植可以使许多 1 型糖尿病患者实现胰岛素独立性，但通常需要输注不止一次胰岛。由于供体器官有限，实现单次供体胰岛移植后胰岛素独立性是临床胰岛移植的一个重要目标。
我们使用单变量和多变量分析来检查与单次供体胰岛移植后胰岛素独立性相关的因素。
在 85 名患者中，有 13 名（15.3%）在接受单次供体胰岛移植后实现了胰岛素独立性。使用多变量分析，只有移植期间使用胰岛素和肝素输注是与胰岛素独立性相关的显著因素，调整后的优势比为 8.6（95%置信区间 2.0-37.0）。接受移植期间胰岛素和肝素输注的患者胰岛移植的植入指数更高，胰岛素使用量减少更多（80.1%+或-4.3%比 54.2%+或-2.8%，P<0.001），即使没有实现胰岛素独立性。
移植期间强化胰岛素和肝素可能会增强胰岛移植的效果，这可能部分与减轻即时血液介导的炎症反应的影响有关，同时还可以使胰岛得到休息和避免炎症。进一步研究移植期间胰岛素和肝素输注对胰岛植入的影响非常重要。
