Pepper Andrew R, Bruni Antonio, Shapiro A M James
Clinical Islet Transplant Program, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
Curr Opin Organ Transplant. 2018 Aug;23(4):428-439. doi: 10.1097/MOT.0000000000000546.
Clinical pancreatic islet transplantation has evolved into a routine means to restore glycemic control in patients with type 1 diabetes mellitus (T1DM) suffering from life-threatening hypoglycemia and severe glucose liability. This chapter examines the current progress in islet transplantation while outlining the remaining limitations preventing this life-altering therapy's application to the broader T1DM population.
Islet transplantation has recently been demonstrated to provide superior glycemic control with reduced glucose lability and hypoglycemic events compared with standard insulin therapy. Transplant outcomes have steadily improved, in part, reflective of refinements, including more optimal islet donors and isolations, safer transplant techniques and more effective anti-inflammatory and immunomodulatory intervention. Furthermore, latest insulin independence rates 5-years posttransplant have reached parity with pancreas transplantation. Successful completion of a recent National Institutes of Health-sponsored Phase III multicenter clinical allogeneic islet transplantation trial confirmed the safety and efficacy of this therapeutic modality and will be used in the Biological Licensure Application by the United States Food and Drug Administration.
Implementation of novel immunosuppression, antiinflammatories, first-in-human stem cell and extrahepatic transplant site trials into clinical investigation has positioned β-cell replacement to become the mainstay treatment for all T1DM patients in the near future.
临床胰岛移植已发展成为一种常规手段，用于恢复1型糖尿病（T1DM）患者的血糖控制，这些患者患有危及生命的低血糖症且血糖波动严重。本章探讨了胰岛移植的当前进展，同时概述了阻碍这种改变生活的疗法应用于更广泛T1DM人群的剩余局限性。
与标准胰岛素治疗相比，最近已证明胰岛移植能提供更好的血糖控制，减少血糖波动和低血糖事件。移植结果稳步改善，部分反映了改进措施，包括更优化的胰岛供体和分离方法、更安全的移植技术以及更有效的抗炎和免疫调节干预。此外，最近移植后5年的胰岛素非依赖率已与胰腺移植相当。美国国立卫生研究院赞助的一项III期多中心临床同种异体胰岛移植试验的成功完成，证实了这种治疗方式的安全性和有效性，并将用于美国食品药品监督管理局的生物许可申请。
将新型免疫抑制、抗炎药物、首例人体干细胞和肝外移植部位试验纳入临床研究，使得β细胞替代疗法在不久的将来有望成为所有T1DM患者的主要治疗方法。
