Baylor Simmons Transplant Institute, Dallas, TX 75246, USA.
Cell Transplant. 2012;21(2-3):553-8. doi: 10.3727/096368911X605475.
Total or partial pancreatectomy followed by autologous islet transplantation is a therapeutic option for the treatment of refractory chronic pancreatitis (CP). Maximization of islet yields from fibrotic and inflamed organs is crucial for prevention of posttransplant diabetes. We adapted technical advancements developed for islet allotransplantation toward islet autotransplantation. Eight patients (two men, six women; ages 24-58 years) underwent total (n = 7) or partial (n = 1) pancreatectomy for the treatment of CP refractory to maximal medical management. Pancreata were preserved in UW solution (UW group) in initial three cases and the last five pancreata were preserved with pancreatic ductal injection followed by ET-Kyoto/oxygenated PFC solutions (DI+TLM group). Islets were isolated by modified Ricordi method and were purified only in one case. All islet infusions were performed under general anesthesia via direct vein injection into the portal venous system with pressure monitoring. Total islet yields (129,314 ± 51,627 vs. 572,841 ± 116,934 IEQ, p < 0.04), islet yield/pancreas weight (1,233 ± 359 vs. 6,848 ± 847 IEQ/g, p < 0.003), and islet yield/patient body weight (1,951 ± 762 vs. 7,305 ± 1,531 IEQ/kg, p < 0.05) were significantly higher in the DI+TLM group when compared to the UW group. Pellet size was also higher (5.3 ± 0.3 vs. 13.5 ± 3.4 ml) in the DI+TLM group, suggesting that this method of preservation effectively protected pancreatic tissue against autolysis. First month posttransplant basal C-peptide and the secretory unit of islet transplant objects (SUITO) index were also higher in the DI+TLM group when compared to the UW group (2.0 ± 0.3 vs. 1.4 ± 0.4 ng/ml and 42.6 ± 12.7 vs. 14.6 ± 5.6, respectively). There were no technical complications related to the infusion. Our results suggest that higher islet yields can be achieved even from chronically inflamed and fibrotic organs using DI+TLM. The techniques applied for islet isolations from normal pancreata are showing promise for fibrotic pancreata from CP patients.
胰腺全切或部分切除后自体胰岛移植是治疗难治性慢性胰腺炎（CP）的一种治疗选择。从纤维化和炎症器官中获得最大的胰岛产量对于预防移植后糖尿病至关重要。我们将开发用于胰岛同种异体移植的技术进步应用于胰岛自体移植。
8 名患者（2 名男性，6 名女性；年龄 24-58 岁）因最大药物治疗无效的 CP 而行胰腺全切除（n=7）或部分切除（n=1）。初始 3 例采用 UW 溶液保存胰腺（UW 组），最后 5 例采用胰腺导管注射后 ET-Kyoto/充氧 PFC 溶液（DI+TLM 组）保存胰腺。胰岛采用改良的 Ricordi 法分离，仅在 1 例中进行纯化。所有胰岛输注均在全身麻醉下通过直接静脉注射门静脉系统，同时监测压力进行。
与 UW 组相比，DI+TLM 组的胰岛总产率（129314±51627 与 572841±116934IEQ，p<0.04）、胰岛产率/胰腺重量（1233±359 与 6848±847IEQ/g，p<0.003）和胰岛产率/患者体重（1951±762 与 7305±1531IEQ/kg，p<0.05）均显著更高。DI+TLM 组的胰岛团块大小也更高（5.3±0.3 与 13.5±3.4ml），提示这种保存方法能有效防止胰腺组织自溶。与 UW 组相比，DI+TLM 组移植后 1 个月基础 C 肽和胰岛移植单位的分泌单位（SUITO）指数也更高（2.0±0.3 与 1.4±0.4ng/ml 和 42.6±12.7 与 14.6±5.6）。输注过程中无技术并发症。
我们的结果表明，即使是从慢性炎症和纤维化的器官中，也可以使用 DI+TLM 获得更高的胰岛产量。应用于从正常胰腺中分离胰岛的技术在 CP 患者的纤维化胰腺中显示出良好的前景。
