Koh Angela, Imes Sharleen, Shapiro Andrew Mark James, Senior Peter A
Department of Medicine, University of Alberta. Edmonton, AB, Canada.
JOP. 2013 Jul 10;14(4):428-31. doi: 10.6092/1590-8577/1440.
Allotransplantation of islets can successfully treat subjects with type 1 diabetes complicated by severe hypoglycemia and erratic glycemic control. Insulin independence is often lost over time due to several factors, including recurrent autoimmunity. Brittle diabetes (frequent hypoglycemia and labile glycemic control) is common after pancreatectomy. This is ameliorated by auto-islet transplantation in pancreatectomized patients who have better glycemic control, even without insulin independence.
We herein report a case where islet allotransplantation was carried out in a patient who had undergone total pancreatectomy. Following two islet infusions, he became insulin independent with excellent glycemic control and remains so currently, more than four years after his second islet infusion. Side effects from immunosuppressive therapy were minimal.
Islet allotransplantation can be considered in selected individuals post-pancreatectomy. The absence of autoimmunity may be advantageous for long term graft function relative to islet allotransplantation in type 1 diabetic recipients.
胰岛同种异体移植能够成功治疗1型糖尿病合并严重低血糖及血糖控制不稳定的患者。随着时间推移，由于多种因素，包括复发性自身免疫，胰岛素非依赖状态常难以维持。胰腺切除术后脆性糖尿病（频繁低血糖及血糖控制不稳定）很常见。在胰腺切除术后的患者中，自体胰岛移植可改善血糖控制，即便无法实现胰岛素非依赖状态。
我们在此报告一例接受了全胰腺切除术的患者接受胰岛同种异体移植的病例。经过两次胰岛输注后，他实现了胰岛素非依赖状态，血糖控制良好，在第二次胰岛输注四年多后的目前依然如此。免疫抑制治疗的副作用极小。
对于部分胰腺切除术后的患者，可考虑进行胰岛同种异体移植。相对于1型糖尿病受者的胰岛同种异体移植，不存在自身免疫可能对移植物的长期功能有益。
