21 May 2009
Ann Transplant 2009; 14(1): 15-15 :: ID: 880248
Clinical auto- and allotransplantation of isolated pancreatic islets program
supported by Ministry of Science was started at Warsaw Medical University in
2008. Previous experimental study with pancreatic islets was done by polish
scientists S. Moskalewski and T. Orłowski. Hypoglicemia is a one of the serius complication in diabetic patients and direct clinical indication for pancreas or pancreatic islets transplantation. One year follow-up was assesed in patients after simultaneously total pancreatectomy with islets autotransplantation and islets allotransplantatation in diabetic recipient 15 months after kidney transplants with chronic immunosuppression. First two case clinical reports: Autotransplantation pancreatic islets was performed on the 9th of May 2008. 40 years old male with severe pancreatitis, who required opiates for pain relief. Treatment included endoscopic following Roux Y to pancreatic duct performed has been done with no benefi cial effect. Consequently was done total pancreatectomy with preservation of duodenum and spleen. Removed pancreas was severely fi brotic with calcification. Only trunk and tail of pancreas weighting 50 grams were used for islets isolation. Isolation was performed using collagenase NB1 with protease NB1 without purification of egzocrine tissue. 50000 IEQ of islet cells has been transplanted into the portal system immediately after islets isolation, which was 1000IEQ/kg of patient body weight. Portal pressure did not exceed 14 mm H[sub]2[/sub]O during injection time (up to 30 min.). After pancreatectomy patient does not require pain killers and his weight increased by 10%. Patients fasting C-peptide before ITx was 0.87 ng/mL. The highest C-peptyde level was 0.6 ng/ml at 7 month and 0.38 ng/ml at 11 months time. HbA1C is <6.5%. Patient requires up to 15 units of insulin per day. Allotransplantation pancreatic islets was performer on the 12th of June 2008. 39 years old female with type I diabetes since 1984. Since 2003 on haemodialysis treatment. In march 2007 the kidney transplantation had been done. Fasting c-peptide before allotransplantation was 0.06 ng/ml, stimulated C-peptide was 0.21 ng/ml. HBA1C was 7.2 mg%. Daily insulin intake was 76 U (1.3 U/kg/ per day). Patient kept weight between 55-58 kg (BMI 20.5-21.5 kg/m2) Within last 6 months, before islets infusion, episodes of hypoglycemia were present 6 times (3 times at night). HLA matching did not revealed incompatibility, cross-match was negative. After islets allotransplantation patient received antibiotics and anticoagulation prophylaxis. Immunsosupresion consisted of: tacrolimus, cellcept, steroids In low dosis and basiliximab. Function of the transplanted kidneys was stable - creatinine level between 1.0 to 1.6 mg/dl, clearance of creatinine 55 ml/kg/min. C-peptide at: 3, 14, 30, 90 and 240 days after islets transplantation was respectively: 1.02; 0.39; 0.79; 0.21; 0.39 ng/ml. Stimulated c-peptide 240 days after islets transplantation was 0.69 ng/ml. Daily insulin intake at 3, 14, 30, 90 and 240 days after islets transplantation was respectively: 48U, 38U, 30U, 50U, 39U. HBA1C at 90 and 240 days after islets transplantation was: 5.9 and 6.0 mg/dl. Due to recent subclinical rejection found in kidney's biopsy, steroids withdrawal was impossible. Qualification for another islets infusion is stopped. In conclusion, islets autotransplantation offers a worthwhile addition to total pancreatectomy as a treatment for chronic
pancreatitis. Even in cases in which insulin independence is not achieved, the effects of positive C-peptide that prevent diabetic complication is important including hypoglicemia episode. Islets allotransplantation is a safe surgical procedure which allows for beter diabetic control and lower daily insulin intake. To receive complet insulin-independence additional islet cells infusion in same cases are recommended.
Keywords: Rational drug use, adverse drug effects( ADE), generic drugs, medication profile, Allotransplantation, autotransplantation
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