Sutherland D E, Goetz F C, Sibley R K
Department of Surgery, University of Minnesota, Minneapolis.
Diabetes. 1989 Jan;38 Suppl 1:85-7. doi: 10.2337/diab.38.1.s85.
In a series of 200 pancreas transplants with 6 mo to less than 9 yr of follow-up, recurrence of disease was identified as the cause of graft failure in 8 cases, all in non- or minimally immunosuppressed recipients of transplants from identical twin (n = 3) or HLA-identical sibling (n = 5) donors. Recurrence of disease was defined as selective loss of beta-cells; other endocrine cell types persisted and appeared normal within the islets of the graft. Isletitis was present in islets with residual beta-cells during the evolution of the process in all nonimmunosuppressed and in some immunosuppressed recipients, but isletitis resolved in all cases in which beta-cell destruction was complete and also resolved in some cases in which residual beta-cells were retained after the introduction of or an increase in immunosuppression. Recurrence of disease can be prevented by immunosuppression, and 2 recipients of identical twin grafts and 12 recipients of grafts from HLA-identical siblings had functioning grafts as of March 1988, the longest greater than 7 yr. The process has not been observed in patients in whom full-dose immunosuppression has been used, including HLA-identical siblings, and this may be the reason no cases of recurrence of disease have been identified in recipients of cadaveric grafts. Alternatively, the observations are consistent with, but not proof of, the hypothesis that recurrence of disease (autoimmune isletitis leading to diabetes) is a major histocompatibility complex-restricted phenomenon.
在一系列200例胰腺移植中，随访时间为6个月至不到9年，8例移植失败的原因被确定为疾病复发，所有这些病例均为来自同卵双胞胎（n = 3）或HLA相同同胞（n = 5）供体的非免疫抑制或最低限度免疫抑制的移植受者。疾病复发被定义为β细胞的选择性丧失；其他内分泌细胞类型持续存在，并且在移植的胰岛内看起来正常。在所有非免疫抑制和一些免疫抑制的受者中，在疾病进展过程中，有残留β细胞的胰岛存在胰岛炎，但在β细胞破坏完全的所有病例中胰岛炎均消退，并且在引入免疫抑制或增加免疫抑制后仍保留残留β细胞的一些病例中胰岛炎也消退。疾病复发可通过免疫抑制来预防，截至1988年3月，2例同卵双胞胎移植受者和12例HLA相同同胞移植受者的移植功能良好，最长的超过7年。在使用全剂量免疫抑制的患者中未观察到该过程，包括HLA相同的同胞，这可能是尸体移植受者中未发现疾病复发病例的原因。或者，这些观察结果与疾病复发（自身免疫性胰岛炎导致糖尿病）是主要组织相容性复合体限制现象的假设一致，但不是证据。
