期刊
TRANSPLANTATION
卷 89, 期 4, 页码 465-471出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/TP.0b013e3181c478fd
关键词
Islet transplantation; Single donor
资金
- Juvenile Diabetes Research Foundation Islet Transplant Center
- National Institutes of Health [DK59101]
- Immune Tolerance Network
- Capital Health and Alberta Health and Wellness (Province Wide Services)
- Roberts Family
- North American Foundation for the Cure of Diabetes
- Alberta Building Trades
- Diabetes Research Institute Foundation Canada (DRIFCan)
- National Medical Research Council-Singapore Totalisator Board Research Fellowship
- FS Chia
- Swiss National Science Foundation
- Alberta Heritage Foundation for Medical Research
Background. Successful islet transplantation can result in insulin independence in many patients with type 1 diabetes mellitus, but it often requires more than one islet infusion. The ability to achieve insulin independence with a single donor is an important goal in clinical islet transplantation due to the limited organ supply. Methods. We examined factors that may be associated with insulin independence after islet transplantation with islets from a single donor, using univariate and multivariate analysis. Results. Thirteen of 85 (15.3%) achieved insulin independence after single-donor islet transplantation. Using multivariate analysis, only the use of insulin and heparin infusions peritransplant was a significant factor associated with insulin independence, with an adjusted odds ratio of 8.6 (95% confidence interval 2.0-37.0). Patients who had received insulin and heparin infusions peritransplant had greater indices of islet engraftment and a greater reduction in insulin use (80.1% +/- 4.3% vs. 54.2% +/- 2.8%, P < 0.001) even if insulin independence was not achieved. Conclusions. Peritransplant intensive insulin and heparin enhances islet transplantation outcomes likely related in part to mitigation of the effects of the instant blood-mediated inflammatory reaction, combined with islet rest and avoidance of inflammation. It would be important to further investigate the effects of peritransplant insulin and heparin infusions on islet engraftment.
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