Ekberg H, Deane S A, Williamson P, Hawthorne W J, Grierson J M, Eastman C J, Stewart G J, Little J M
Sydney University Department of Surgery, Westmead Hospital, New South Wales, Australia.
Transplantation. 1988 Jul;46(1):21-5. doi: 10.1097/00007890-198807000-00002.
In clinical pancreas transplantation, duct-occluded segmental allografts are often used. There is concern that fibrosis following duct-occlusion may lead to progressive graft failure. In this study, sequential histology and endocrine function in long-term (up to 5 years) canine autografts were assessed. Segmental pancreatic autografts with residual pancreatectomy were performed, and the pancreatic duct was occluded with cyanoacrylate glue. Serial i.v. glucose tolerance tests (IVGTT) and percutaneous needle-core biopsies of the grafts were performed as long as grafts functioned. Ten dogs were long-term (greater than 18 months) survivors: 8 dogs had functioning grafts for a median of 48 months (range 18-60) after transplantation, and 3 dogs had graft failure at 21, 27, and 60 months. The mean 40-min blood glucose concentration (BGL-40') after i.v. glucose injection did not increase with time up to 5 years after grafting. Graft biopsies showed a universal picture of aggregated islet cells and fibrous replacement of acinar tissue. The total amount of fibrosis did not change with time, but the existing fibrosis became less cellular and more dense. This long-term study showed that in autografted animals, adequate endocrine function was maintained in the majority of cases, and progressive replacement of islet tissue by fibrosis could not be demonstrated in serial biopsies taken between 18 months and 5 years after autotransplantation. We therefore conclude, that while duct-occlusion results in extensive fibrosis, the process is not progressive, and although fibrosis may contribute to late graft failure this is not inevitable.
在临床胰腺移植中，常使用导管闭塞的节段性同种异体移植物。有人担心导管闭塞后的纤维化可能导致移植物逐渐衰竭。在本研究中，评估了长期（长达5年）犬自体移植物的连续组织学和内分泌功能。进行了保留部分胰腺切除术的节段性胰腺自体移植，并使用氰基丙烯酸酯胶闭塞胰管。只要移植物仍有功能，就进行连续的静脉葡萄糖耐量试验（IVGTT）和经皮针芯活检。10只狗为长期（超过18个月）存活者：8只狗在移植后中位48个月（范围18 - 60个月）移植物功能良好，3只狗在21、27和60个月时移植物失败。静脉注射葡萄糖后40分钟的平均血糖浓度（BGL - 40'）在移植后长达5年的时间里未随时间增加。移植物活检显示胰岛细胞聚集和腺泡组织纤维性替代的普遍情况。纤维化总量未随时间变化，但现有的纤维化细胞成分减少且密度增加。这项长期研究表明，在自体移植的动物中，大多数情况下内分泌功能得以维持，并且在自体移植后18个月至5年期间进行的连续活检中未发现胰岛组织被纤维化逐渐替代的情况。因此我们得出结论，虽然导管闭塞会导致广泛纤维化，但该过程并非进行性的，并且尽管纤维化可能导致晚期移植物失败，但这并非不可避免。
