Fiedor P, Goodman E R, Sung R S, Czerwiński J, Rowiński W, Hardy M A
Department of Surgery, College of Physicians and Surgeons of Columbia University, New York, USA.
Ann Transplant. 1996;1(1):59-62.
The recovery of pancreatic islet cells from cadaveric donors for allotransplantation may depend on the functional condition of the pancreas of the donor prior to organ harvesting. We examined donor hemodynamic and biochemical parameters and their effects on the subsequent yield of islet cells after harvesting. All pancreata were flushed and preserved in University of Wisconsin (UW) solution and digested using automated method within 8 hours. In the first analysis, digestions were divided into high-yield (> 2000 IEQ/g pancreas), and low-yield (< 2000 IEQ/g) groups and donor variables were averaged for each group. Donors whose pancreata yielded > 2000 IEQ/g received significantly greater amounts of Dopamine (14.43 micrograms/kg/min vs 9.35 mg/kg/min, p = 0.05). The daily urine output between groups was also significantly different. Maximum systolic blood pressure (SBP), minimum systolic blood pressure, use of vasopressin, length of hospitalization, and maximum base deficit were compared between the two groups. Less severe hypoglycemia (lowest blood glucose 143 mg/dL vs 107 mg/dL, p = 0.02) and lower amylase levels (36.2 U vs 80.7, p = 0.07 were noted in the high-yield group. A trend towards higher islet yields was associated with lowest hourly urine output > 60 (2040 IEQ/g vs 1649 IEQ/g p = 0.09), maximum SBP > 200 (2097 vs 1673, p = 0.07, and surprisingly, lowest SBP below 80 (2013 vs 1742, p < 0.1). Amount of fluids administered prior to procurement had no influence on islet yield. In conclusion, hemodynamic variables such as urine output, systolic blood pressure, and degree of pressor support were modestly associated with successful islet isolation. The preliminary data suggest that better multifactor donor analysis is imperative for standardization and monitoring of multiorgan donors. The association of higher blood glucose levels with successful isolation may also be related to resuscitation with dextrose-containing fluids.
从尸体供体获取胰腺胰岛细胞用于同种异体移植，其成功率可能取决于器官获取前供体胰腺的功能状态。我们检测了供体的血流动力学和生化参数，以及它们对获取后胰岛细胞后续产量的影响。所有胰腺均用威斯康星大学（UW）溶液冲洗并保存，并在8小时内采用自动化方法进行消化。在首次分析中，消化分为高产组（>2000 IEQ/g胰腺）和低产组（<2000 IEQ/g），并对每组的供体变量进行平均。胰腺产量>2000 IEQ/g的供体接受多巴胺的量显著更多（14.43微克/千克/分钟对9.35毫克/千克/分钟，p = 0.05）。两组之间的每日尿量也有显著差异。比较了两组之间的最高收缩压（SBP）、最低收缩压、血管加压素的使用、住院时间和最大碱缺失。高产组的低血糖程度较轻（最低血糖143毫克/分升对107毫克/分升，p = 0.02），淀粉酶水平较低（36.2 U对80.7 U，p = 0.07）。胰岛产量较高的趋势与最低每小时尿量>60（2040 IEQ/g对1649 IEQ/g，p = 0.09）、最高SBP>200（2097对1673，p = 0.07）以及令人惊讶的最低SBP低于80（2013对1742，p < 0.1）有关。获取前给予的液体量对胰岛产量没有影响。总之，诸如尿量、收缩压和升压支持程度等血流动力学变量与胰岛成功分离有一定关联。初步数据表明，更好的多因素供体分析对于多器官供体的标准化和监测至关重要。较高血糖水平与成功分离之间的关联也可能与含葡萄糖液体的复苏有关。
