Gerber Philipp A, Hochuli Michel, Benediktsdottir Bara D, Zuellig Richard A, Tschopp Oliver, Glenck Michael, de Rougemont Olivier, Oberkofler Christian, Spinas Giatgen A, Lehmann Roger
Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Zurich, Switzerland.
Division of Radiology, University Hospital Zurich, Zurich, Switzerland.
Clin Transplant. 2018 Jan;32(1). doi: 10.1111/ctr.13153. Epub 2017 Dec 8.
The aim of this study was to assess safety and efficacy of islet transplantation after initial pancreas transplantation with subsequent organ failure. Patients undergoing islet transplantation at our institution after pancreas organ failure were compared to a control group of patients with pancreas graft failure, but without islet transplantation and to a group receiving pancreas retransplantation. Ten patients underwent islet transplantation after initial pancreas transplantation failed and were followed for a median of 51 months. The primary end point of HbA1c <7.0% and freedom of severe hypoglycemia was met by nine of 10 patients after follow-up after islet transplantation and in all three patients in the pancreas retransplantation group, but by none of the patients in the group without retransplantation (n = 7). Insulin requirement was reduced by 50% after islet transplantation. Kidney function (eGFR) declined with a rate of -1.0 mL ± 1.2 mL/min/1.73 m per year during follow-up after islet transplantation, which tended to be slower than in the group without retransplantation (P = .07). Islet transplantation after deceased donor pancreas transplant failure is a method that can safely improve glycemic control and reduce the incidence of severe hypoglycemia and thus establish similar glycemic control as after initial pancreas transplantation, despite the need of additional exogenous insulin.
本研究的目的是评估在初次胰腺移植后出现器官功能衰竭时进行胰岛移植的安全性和有效性。将在本院接受胰腺器官功能衰竭后胰岛移植的患者与胰腺移植失败但未进行胰岛移植的对照组患者以及接受胰腺再次移植的患者组进行比较。10例患者在初次胰腺移植失败后接受了胰岛移植，并进行了中位时间为51个月的随访。胰岛移植后随访时，10例患者中有9例达到了糖化血红蛋白（HbA1c）<7.0%且无严重低血糖发作的主要终点，胰腺再次移植组的所有3例患者也达到了该终点，但未进行再次移植的患者组（n = 7）中无一例达到该终点。胰岛移植后胰岛素需求量减少了50%。胰岛移植后随访期间，肾功能（估算肾小球滤过率[eGFR]）以每年-1.0 mL±1.2 mL/min/1.73 m²的速率下降，这一速率往往比未进行再次移植的组要慢（P = 0.07）。尽管需要额外的外源性胰岛素，但在已故供体胰腺移植失败后进行胰岛移植是一种能够安全改善血糖控制并降低严重低血糖发生率的方法，从而实现与初次胰腺移植后相似的血糖控制。
