title: Pancreatic islet transplantation after upper abdominal exenteration and liver replacement.
abstract: Nine patients who became diabetic after upper-abdominal exenteration and liver transplantation were given pancreatic islet-cell grafts obtained from the liver donor (eight cases), a third-party donor (one), or both (four). Two patients were diabetic when they died of infections after 48 and 109 days, as was a third patient who died of tumour recurrence after 178 days. The other 6 are alive 101-186 days postoperatively, and five are insulin-free or on insulin only during night-time parenteral alimentation. C-peptide increased 1.7 to 3.3 fold in response to intravenous glucose in these five patients who have had glycosylated haemoglobin in the high normal range. However, the kinetics of the C-peptide responses to intravenous glucose in all eight patients tested revealed an absent first-phase release and a delayed peak response consistent with transplantation and/or engraftment of a suboptimal islet cell mass. The longest survivor, who requires neither parenteral alimentation nor insulin, is the first unequivocal example of successful clinical islet-cell transplantation.
authors.affiliation: Department of Surgery, Medicine, University of Pittsburgh, Pennsylvania 15213.
authors.forename: A G
authors.initials: AG
authors.lastname: Tzakis
authors.forename: C
authors.initials: C
authors.lastname: Ricordi
authors.forename: R
authors.initials: R
authors.lastname: Alejandro
authors.forename: Y
authors.initials: Y
authors.lastname: Zeng
authors.forename: J J
authors.initials: JJ
authors.lastname: Fung
authors.forename: S
authors.initials: S
authors.lastname: Todo
authors.forename: A J
authors.initials: AJ
authors.lastname: Demetris
authors.forename: D H
authors.initials: DH
authors.lastname: Mintz
authors.forename: T E
authors.initials: TE
authors.lastname: Starzl
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007515:Islets of Langerhans / Q000502:physiology; D016381:Islets of Langerhans Transplantation; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery; D011182:Postoperative Care; D016019:Survival Analysis