Baylor All Saints Islet Cell Laboratory, Fort Worth, TX 76104, USA.
Cell Transplant. 2012;21(4):625-32. doi: 10.3727/096368911X623899. Epub 2012 Feb 2.
Autologous islet transplantation after total pancreatectomy is an excellent treatment for painful chronic pancreatitis. Traditionally, islets have been isolated without purification; however, purification is applied when the tissue volume is large. Nevertheless, the impact of tissue volume and islet purification on clinical outcomes of autologous islet transplantation has not been well examined. We analyzed 27 cases of autologous islet transplantation performed from October 2006 to January 2011. After examining the relationship between tissue volume and portal pressure at various time points, we compared islet characteristics and clinical outcomes between cases with complications (complication group) and without (noncomplication group), as well as cases with purification (purification group) and without (nonpurification group). Tissue volume significantly correlated with maximum (R = 0.61), final (R = 0.53), and delta (i.e., difference between base and maximum; R = 0.71) portal pressure. The complication group had a significantly higher body mass index, tissue volume, islet yield, and portal pressure (maximum, final, delta), suggesting that complications were associated with high tissue volume and high portal pressure. Only one of four patients (25%) in the complication group became insulin free, whereas 11 of 23 patients (49%) in the noncomplication group became insulin free with smaller islet yields. The purification group had a higher islet yield and insulin independence rate but had similar final tissue volume, portal pressure, and complication rates compared with the nonpurification group. In conclusion, high tissue volume was associated with high portal pressure and complications in autologous islet transplantation. Islet purification effectively reduced tissue volume and had no negative impact on islet characteristics. Therefore, islet purification can reduce the risk of complications and may improve clinical outcome for autologous islet transplantation when tissue volume is large.
自体胰岛移植治疗慢性胰腺炎疼痛有效。传统上，胰岛是未经纯化而被分离的，但当组织体积较大时，则会进行纯化。然而，组织体积和胰岛纯化对自体胰岛移植临床结果的影响尚未得到很好的研究。我们分析了 2006 年 10 月至 2011 年 1 月期间进行的 27 例自体胰岛移植病例。在检查了不同时间点的组织体积与门静脉压之间的关系后，我们比较了有并发症（并发症组）和无并发症（无并发症组）、有纯化（纯化组）和无纯化（无纯化组）病例的胰岛特征和临床结果。组织体积与最大门静脉压（R = 0.61）、最终门静脉压（R = 0.53）和门静脉压差值（即基础值与最大压之间的差值；R = 0.71）显著相关。并发症组的体重指数、组织体积、胰岛产量和门静脉压（最大压、最终压和差值）均显著较高，提示并发症与高组织体积和高门静脉压有关。并发症组中仅有 1/4（25%）的患者实现了胰岛素无依赖，而无并发症组中 11/23（49%）的患者在胰岛产量较低的情况下实现了胰岛素无依赖。与无纯化组相比，纯化组的胰岛产量和胰岛素独立性较高，但最终组织体积、门静脉压和并发症发生率相似。总之，高组织体积与自体胰岛移植中的门静脉压升高和并发症相关。胰岛纯化可有效减少组织体积，且对胰岛特征无负面影响。因此，当组织体积较大时，胰岛纯化可降低并发症风险，并可能改善自体胰岛移植的临床结果。
