Alejandro R
Diabetes Research Institute, University of Miami School of Medicine, Florida 331012, USA.
Scand J Gastroenterol Suppl. 1995;208:125-8. doi: 10.3109/00365529509107773.
From 1974 to December, 1992, as reported by the International Islet Transplant Registry, there have been 175 adult islet allografts worldwide. Ninety-eight of these transplants have been performed since 1989. Eleven patients with Type I diabetes mellitus who have received islet allografts since 1989 have achieved insulin-independence for variable periods of time. As of June, 1993, four patients remain insulin-independent (from > 127 to > 326 days). Insulin-independence after human islet cell transplantation is not yet a consistent achievement. Several key issues in pancreas procurement, islet cell isolation, islet preservation, islet engraftment and the prevention of islet allograft rejection still need to be addressed. The expansion of current clinical trials should be limited to patients who are taking or who require immunosuppressive drugs for other reasons (kidney or liver transplant recipient) since the risks of chronic immunosuppression probably outweight the risks from chronic diabetes, although as we are able to induce a more specific state of immunosuppression this rationale may become debatable.
据国际胰岛移植登记处报告，从1974年到1992年12月，全球共进行了175例成人胰岛同种异体移植。其中98例移植是自1989年以来进行的。自1989年以来接受胰岛同种异体移植的11例I型糖尿病患者在不同时间段内实现了胰岛素自主分泌。截至1993年6月，有4例患者仍保持胰岛素自主分泌（时间超过127天至超过326天）。人类胰岛细胞移植后实现胰岛素自主分泌尚未成为一项稳定的成果。胰腺获取、胰岛细胞分离、胰岛保存、胰岛植入以及预防胰岛同种异体移植排斥反应等几个关键问题仍有待解决。目前临床试验的扩大应仅限于正在服用或因其他原因（肾或肝移植受者）需要免疫抑制药物的患者，因为慢性免疫抑制的风险可能超过慢性糖尿病的风险，不过随着我们能够诱导更具特异性的免疫抑制状态，这一理论依据可能会受到质疑。
