冷藏保存6至26小时后移植的人胰腺同种异体移植物的功能。

Function of transplanted human pancreatic allografts after preservation in cold storage for 6 to 26 hours.

作者信息

Abouna G M, Sutherland D E, Florack G, Najarian J S

出版信息

Transplantation. 1987 May;43(5):630-6. doi: 10.1097/00007890-198705000-00005.

DOI:10.1097/00007890-198705000-00005

Abstract

Preservation of cadaveric pancreas allografts has been a difficult problem in clinical pancreas transplantation; most institutions use Collins solution and limit preservation time to less than 6 hr. Longer preservation times have been used at the University of Minnesota. Between August 1983, and December 1985, 47 human cadaveric pancreas grafts were transplanted into Type I diabetic recipients after cold storage at 4 degrees C in a modified, hyperosmolar silica-gel filtered plasma (SGFP), a solution previously found to allow dog pancreas grafts to be successfully preserved for up to 48 hr. Ten grafts were preserved for 2-5 hr (group 1); 20 for 6-11 hr (group 2; 17 for 12-26 hr (group 3). Graft function and late outcome were compared between these groups and another group of 7 cadaveric grafts (group 4), which were transplanted immediately and without any preservation. Analysis of exocrine pancreatic function early after transplantation showed a maximum mean serum amylase (IU/L) of 557, 440, 429, and 307 in groups 1, 2, 3, and 4, respectively. Primary preservation failure rates of 0, 5%, 5.8%, and 0%, and endocrine graft function rates at 1 month of 80%, 80%, 76%, and 86% were obtained for groups 1, 2, 3, and 4, respectively (P = NS). Only patients who were insulin-independent were counted as having functioning grafts. Detailed functional studies at 1 month showed that mean plasma glucose levels during 24-hr metabolic profiles were in the normal range in 71%, 68%, 72%, and 50%, while oral glucose tolerance test results were within the normal range in 38%, 81%, 76%, and 66% of groups 1, 2, 3, and 4, respectively (P = NS). At 1 year, patient survival rates were 57%, 88%, 75%, and 100% (P = NS), and the graft functional survival rates were 0, 25%, 33%, and 29% (P = NS) in the respective groups. Five patients in group 2, and 6 in group 3 have currently functioning grafts at 4 to 37 months after transplantation. We conclude that cadaver pancreas grafts can be safely preserved for 12-24 hr in modified SGFP solution, thus making the sharing of these organs between different centers practical and the transplant operation less of an emergency procedure.

摘要

尸体胰腺同种异体移植物的保存一直是临床胰腺移植中的难题；大多数机构使用柯林斯溶液，并将保存时间限制在6小时以内。明尼苏达大学使用了更长的保存时间。在1983年8月至1985年12月期间，47例人类尸体胰腺移植物在4℃下于改良的高渗硅胶过滤血浆（SGFP）中冷藏后，移植给I型糖尿病受者，此前发现该溶液可使犬胰腺移植物成功保存长达48小时。10例移植物保存2 - 5小时（第1组）；20例保存6 - 11小时（第2组）；17例保存12 - 26小时（第3组）。比较了这些组与另一组7例尸体移植物（第4组）的移植物功能和远期结果，第4组移植物未进行任何保存即立即移植。移植后早期对外分泌胰腺功能的分析显示，第1、2、3和4组的血清淀粉酶平均最高值（IU/L）分别为557、440、429和307。第1、2、3和4组的原发性保存失败率分别为0%、5%、5.8%和0%，1个月时内分泌移植物功能率分别为80%、80%、76%和86%（P = 无显著差异）。仅将不依赖胰岛素的患者视为移植物功能正常。1个月时的详细功能研究表明，在24小时代谢谱期间，第1、2、3和4组的平均血浆葡萄糖水平在正常范围内的比例分别为71%、68%、72%和50%，而口服葡萄糖耐量试验结果在正常范围内的比例分别为38%、81%、76%和66%（P = 无显著差异）。1年时，各组患者生存率分别为57%、88%、75%和100%（P = 无显著差异），移植物功能生存率分别为0%、25%、33%和29%（P = 无显著差异）。第2组的5例患者和第3组的6例患者在移植后4至37个月时移植物目前功能正常。我们得出结论，尸体胰腺移植物在改良的SGFP溶液中可安全保存12 - 24小时，从而使不同中心之间共享这些器官成为现实，并且移植手术不再那么紧急。