1 Division of Advanced Surgical Science and Technology, Tohoku University, Sendai, Japan. 2 New Industry Creation Hatchery Center, Tohoku University, Sendai, Japan. 3 Department of Pathology, Tohoku University School of Medicine, Sendai, Japan. 4 Division of Diabetes & Metabolism, Hyogo College of Medicine, Nishinomiya, Japan. 5 Address correspondence to: Masafumi Goto, M.D., Ph.D., New Industry Creation Hatchery Center, Tohoku University, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-0872, Japan.
Transplantation. 2014 Feb 15;97(3):280-6. doi: 10.1097/01.tp.0000437557.50261.b9.
Several studies have revealed that posttransplant insulin treatment is beneficial to rest the islet grafts. However, insulin infusion per se is not enough to completely suppress the heavy workload arising caused by postprandial hyperglycemia. Therefore, the present study examined whether short-term fasting combined with insulin treatment could effectively prevent graft exhaustion after intraportal islet transplantation.
A marginal dose of syngeneic rat islet grafts were transplanted intraportally into the control, insulin-treated, and insulin+rest groups of streptozotocin-induced diabetic rats. The control group fed freely without insulin treatment, and the other groups were continuously treated with an optimal amount of insulin to maintain normoglycemia. In addition, the insulin+rest group fasted and received total parenteral nutrition during the 2 weeks after transplantation.
The curative rate was significantly higher in both the insulin and insulin+rest groups than the control group (P<0.0001). The glucose tolerance, residual graft mass, and graft function were significantly ameliorated in the insulin+rest group, but not in the insulin group, compared to the control group (P<0.01, P=0.03, P=0.001).
These data suggest that short-term fasting combined with insulin treatment, especially during the avascular period of the grafts, could therefore be a promising regimen for improving pancreatic islet engraftment in the liver.
多项研究表明，移植后胰岛素治疗有益于使胰岛移植物得到休息。然而，单纯的胰岛素输注不足以完全抑制餐后高血糖引起的繁重工作量。因此，本研究探讨了短期禁食联合胰岛素治疗是否能有效防止门静脉内胰岛移植后移植物衰竭。
将边缘剂量的同种异体大鼠胰岛移植到链脲佐菌素诱导的糖尿病大鼠的对照组、胰岛素治疗组和胰岛素+休息组门静脉内。对照组自由进食，不进行胰岛素治疗，而其他两组则连续给予最佳剂量的胰岛素以维持正常血糖。此外，胰岛素+休息组在移植后 2 周内禁食并接受全胃肠外营养。
胰岛素组和胰岛素+休息组的治愈率均明显高于对照组（P<0.0001）。与对照组相比，胰岛素+休息组的葡萄糖耐量、残留移植物质量和移植物功能明显改善，但胰岛素组没有改善（P<0.01，P=0.03，P=0.001）。
这些数据表明，短期禁食联合胰岛素治疗，特别是在移植物的无血管期，可能是改善肝脏胰岛移植的一种有前途的方案。
