Diabetes Research Institute and Cell Transplant Center, University of Miami, Miami, FL, USA.
Cell Transplant. 2012;21(6):1261-7. doi: 10.3727/096368911X600984. Epub 2011 Sep 22.
An emergency autologous islet transplant after a traumatic Whipple operation and subsequent total pancreatectomy was performed for a 21-year-old patient who was wounded with multiple abdominal gunshot wounds. After Whipple pancreatectomy, the remnant pancreas (63.5 g), along with other damaged organs, was removed by the surgeons at Walter Reed Army Medical Center (WRAMC) and shipped to Diabetes Research Institute (DRI) for islet isolation. The pancreas was preserved in UW solution for 9.25 h prior to islet isolation. Upon arrival, the organ was visually inspected; the pancreatic head was missing, the rest of the pancreas was damaged and full of blood; the tail looked normal. A 16-gauge catheter was inserted into the main duct and directed towards tail of the pancreas after the dissection of main duct in the midbody of the pancreas. The pancreas was distended with collagenase solution (Roche MTF) through the catheter. During 10 min of intraductal delivery of enzyme, the gland was distended uniformly. No leakage of the solution was observed. The pancreas was transferred to a Ricordi chamber for automated mechanical and enzymatic digestion. Islets were purified using a COBE 2991 cell processor. Islet equivalents (IEQ; 221,250) of 40% purity and 90% viability were recovered during the isolation, which were shipped back to WRAMC and infused by intraportal injection into the patient. Immediate islet function was demonstrated by the rapid elevation of serum C peptide followed by insulin independence with near normal oral glucose tolerance test (OGTT) 1 and 2 months later. It is possible to restore near normal glucose tolerance with autologous islet transplantation after total pancreatectomy even with suboptimal number of islets while confirming that islets processed at a remote site are suitable for transplantation.
一名 21 岁的患者因多处腹部枪伤而接受了创伤性胰十二指肠切除术和随后的全胰切除术，之后进行了紧急自体胰岛移植。在胰十二指肠切除术后，外科医生将残胰（63.5 克）和其他受损器官从 Walter Reed 陆军医学中心（WRAMC）切除并运往糖尿病研究所（DRI）进行胰岛分离。在胰岛分离前，将胰腺用 UW 溶液保存 9.25 小时。到达后，对器官进行了肉眼检查；胰头缺失，其余胰腺受损并充满血液；胰尾看起来正常。在胰腺中体部解剖主胰管后，将 16 号导管插入主胰管并指向胰尾。通过导管向胶原酶溶液（罗氏 MTF）中扩张胰腺。在 10 分钟的腔内酶输送过程中，腺体均匀扩张。未观察到溶液泄漏。将胰腺转移到 Ricordi 室中进行自动机械和酶消化。使用 COBE 2991 细胞处理器纯化胰岛。在分离过程中，共回收了 40%纯度和 90%活力的胰岛当量（IEQ；221,250），并将其运回 WRAMC 并通过门静脉注射到患者体内。通过 C 肽的快速升高立即证明了胰岛的功能，随后在 1 个月和 2 个月后胰岛素依赖性接近正常口服葡萄糖耐量试验（OGTT）。即使胰岛数量不理想，通过全胰切除后进行自体胰岛移植也有可能恢复接近正常的葡萄糖耐量，同时确认在远程地点处理的胰岛适合移植。
