Hering B J, Browatzki C C, Schultz A, Bretzel R G, Federlin K F
Department of Medicine, Justus-Liebig-University, Giessen, Germany.
Cell Transplant. 1993 Jul-Aug;2(4):269-82; discussion 283-305. doi: 10.1177/096368979300200403.
This review provides the results of a recent analysis of the Islet Transplant Registry on clinical adult islet transplants performed worldwide through June 30, 1992. Between December 12, 1893 and June 30, 1992, 167 adult islet transplants were performed at 25 institutions worldwide, including 104 at 9 institutions in North America, 62 at 15 institutions in Europe, and 1 elsewhere. The total number of diabetic patients reported to be insulin independent after adult islet allotransplantation through June 30, 1992, was 19. In an analysis by era, the percentage of patients that showed positive basal C-peptide levels (i.e., > or = 1 ng/mL at > or = 1 mo) posttransplant, and that became insulin independent (> 1 wk) in the 1985-1989 era (n = 35 cases) were 20% and 6%, and in the 1990-1992 era (n = 69 cases) were 64% and 20%, respectively, and thus have improved significantly (p < 0.001 and p < 0.05). For the 1990-1992 period, the percentage of patients who showed positive basal C-peptide levels post-transplant, and who became insulin independent in the single donor pancreas group (n = 31 cases) were 52% and 13%, and in the multiple donor pancreata group (n = 36 cases) were 75% and 28%, respectively. Islet graft function rates were nearly identical for grafts prepared from pancreata stored < or = 6 h (n = 27) and > 6 < or = 12 h (n = 29), so that 67% and 72% showed positive basal C-peptide levels, and 30% and 21% of the recipients became insulin independent, respectively. No single patient showed islet graft function sufficient to allow withdrawal from insulin, if the pancreata have been stored for more than 12 h. In regard to recipient category for the six groups, namely IAK (islet after kidney), SIK (simultaneous islet kidney transplantation), SIL (simultaneous islet liver transplantation), SIL(C) (simultaneous islet liver transplantation after cluster operation), SIKL (simultaneous islet kidney liver transplantation), and SIH-L (simultaneous islet heart-lung transplantation), the number of patients who showed positive basal C-peptide levels post-transplant was 11 (58%), 17 (57%), 5 (83%), 8 (80%), 1 (50%), and 0 (0%), and the number of insulin independent patients was 4 (21%), 4 (13%), 0 (0%), 6 (60%), 0 (0%), and 0 (0%), respectively. Comparing the two largest recipient categories, namely IAK and SIK, no difference in the outcome of these transplants was apparent.(ABSTRACT TRUNCATED AT 400 WORDS)
本综述给出了近期对胰岛移植登记处的分析结果，该分析涉及截至1992年6月30日在全球范围内进行的成人胰岛临床移植。在1893年12月12日至1992年6月30日期间，全球25家机构共进行了167例成人胰岛移植，其中北美9家机构进行了104例，欧洲15家机构进行了62例，其他地区1家机构进行了1例。截至1992年6月30日，据报告在成人胰岛同种异体移植后无需使用胰岛素的糖尿病患者总数为19例。按时间段分析，在1985 - 1989年期间（n = 35例），移植后基础C肽水平呈阳性（即≥1个月时≥1 ng/mL）且无需使用胰岛素（>1周）的患者百分比分别为20%和6%；在1990 - 1992年期间（n = 69例），这两个百分比分别为64%和20%，且均有显著改善（p<0.001和p<0.05）。在1990 - 1992年期间，单供体胰腺组（n = 31例）移植后基础C肽水平呈阳性且无需使用胰岛素的患者百分比分别为52%和13%，多供体胰腺组（n = 36例）分别为75%和28%。胰岛移植功能率在保存时间≤6小时（n = 27）和>6≤12小时（n = 29）的胰腺所制备的移植物中几乎相同，分别有67%和72%的移植物基础C肽水平呈阳性，受体中分别有30%和21%无需使用胰岛素。如果胰腺保存时间超过12小时，没有患者的胰岛移植功能足以使其停用胰岛素。关于六组受体类别，即肾后胰岛移植（IAK）、胰岛肾同期移植（SIK）、胰岛肝同期移植（SIL）、集群手术后胰岛肝同期移植（SIL(C)）、胰岛肾肝同期移植（SIKL）和胰岛心肺同期移植（SIH - L），移植后基础C肽水平呈阳性的患者数量分别为11例（58%）、17例（57%）、5例（83%）、8例（80%）、1例（50%）和0例（0%），无需使用胰岛素的患者数量分别为4例（21%）、4例（13%）、0例（0%）、6例（60%）、0例（0%）和0例（0%）。比较两个最大的受体类别，即IAK和SIK，这些移植的结果没有明显差异。（摘要截选至400字）
