Wszola M, Berman A, Gorski L, Ostaszewska A, Serwanska-Swietek M, Krajewska M, Lipinska A, Chmura A, Kwiatkowski A
Foundation of Research and Science Development, Otwock, Poland.
Foundation of Research and Science Development, Otwock, Poland.
Transplant Proc. 2018 Sep;50(7):2119-2123. doi: 10.1016/j.transproceed.2018.02.138. Epub 2018 Mar 14.
Total pancreatectomy and autologous transplantation of pancreatic islets is a treatment option for patients with severe pain due to chronic pancreatitis. In the standard procedure, pancreatic islets are isolated and subsequently administered into the portal vein. In the case of patients with a history of thrombosis or at risk of thrombosis, this route of administration is not viable. Animal studies conducted in our department led to the development of a technique of endoscopic islets transplantation into the gastric submucosa. In 2013 and 2014, the first human autologous transplant procedures were performed. The objective of this study was to present the results of a 3-year follow-up of these patients.
Two pancreatectomies were performed in our department, the first in 2013 and another in 2014, along with subsequent autologous transplantation of pancreatic islets into the gastric submucosa.
Both patients had been diagnosed previously with diabetes, and both had endogenous islet activity detected. Peptide C concentration after pancreatectomy and before pancreatic cell transplantation was 0.1 ng/mL. After the transplantation, peptide C concentrations for the 2 patients were 0.8 and 0.5 ng/mL on day 7, 1.2 and 0.6 ng/mL on day 30, 1.3 and 0.8 ng/mL on day 180, 1.1 and 0.7 ng/mL on day 360, and 3.0 and 0.6 ng/mL at 3 years, respectively, after transplantation. The pain symptoms resolved in both cases.
Pancreatic islets may survive in the gastric wall. Endoscopic submucosal transplantation may present an alternative for the management of patients who cannot undergo a classic transplantation procedure.
全胰切除术及自体胰岛移植是治疗慢性胰腺炎所致严重疼痛患者的一种治疗选择。在标准手术中，胰岛被分离出来，随后注入门静脉。对于有血栓形成病史或有血栓形成风险的患者，这种给药途径不可行。我们科室进行的动物研究促成了一种将胰岛内镜下移植到胃黏膜下层的技术的发展。在2013年和2014年，进行了首例人类自体移植手术。本研究的目的是展示对这些患者进行3年随访的结果。
我们科室进行了两例全胰切除术，第一例于2013年进行，另一例于2014年进行，随后将自体胰岛移植到胃黏膜下层。
两名患者此前均被诊断患有糖尿病，且均检测到内源性胰岛活性。全胰切除术后及胰腺细胞移植前的肽C浓度为0.1 ng/mL。移植后，两名患者在移植后第7天的肽C浓度分别为0.8和0.5 ng/mL，第30天为1.2和0.6 ng/mL，第180天为1.3和0.8 ng/mL，第360天为1.1和0.7 ng/mL，3年时分别为3.0和0.6 ng/mL。两例患者的疼痛症状均得到缓解。
胰岛可能在胃壁内存活。内镜下黏膜下移植可能为无法接受经典移植手术的患者提供一种替代治疗方法。
