Sutherland D E
University of Minnesota, Department of Surgery, Minneapolis 55455, USA.
Transplant Proc. 1996 Aug;28(4):2131-3.
Pancreas transplantation currently can be offered with the same probability of success as other solid organ transplants. In diabetic uremic recipients of kidney transplants, the addition of a pancreas is routine in many centers. For selected patients with labile diabetes and hypoglycemia unawareness, a successful pancreas transplant can dramatically improve quality of life. Islet transplantation is an alternative to pancreas transplantation that can reduce surgical morbidity, but is much less successful at the moment. The theoretical, immunological advantages of islet transplantation have not yet been realized. Part of the problem lies in the reduced beta cell mass that occurs with organ dispersal and islet purification. Diabetogenic immunosuppressants need to be eliminated in order to allow optimal function of what is engrafted. The immunosuppressants (eg, mycophenolate mofetil, rapamycin) give this possibility. Whether islet transplantation will replace pancreas transplantation remains problematic. Ultimately, and neither should be needed for Type I diabetes, since autoimmune diseases should be preventable by appropriate manipulation of the immune system in those identified at risk. Our personal goals as transplanters should be obsolescence.
目前，胰腺移植的成功率与其他实体器官移植相当。在接受肾移植的糖尿病尿毒症患者中，许多中心常规会加做胰腺移植。对于部分患有不稳定型糖尿病且无低血糖感知的患者，成功的胰腺移植可显著改善生活质量。胰岛移植是胰腺移植的一种替代方案，它能降低手术并发症，但目前成功率要低得多。胰岛移植在理论上的免疫学优势尚未实现。部分问题在于器官分散和胰岛纯化过程中会出现β细胞数量减少。为使移植的胰岛发挥最佳功能，需要停用致糖尿病的免疫抑制剂。免疫抑制剂（如霉酚酸酯、雷帕霉素）提供了这种可能性。胰岛移植是否会取代胰腺移植仍存在疑问。最终，对于1型糖尿病患者而言，这两种移植可能都不再必要，因为通过对有风险人群的免疫系统进行适当调控，自身免疫性疾病应是可预防的。作为移植医生，我们个人的目标应该是让这些治疗手段过时。
