Pancreatic islet transplantation after upper abdominal exenteration and liver replacement.
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.
Tzakis
A G
AG
Department of Surgery, Medicine, University of Pittsburgh, Pennsylvania 15213.
Ricordi
C
C
Alejandro
R
R
Zeng
Y
Y
Fung
J J
JJ
Todo
S
S
Demetris
A J
AJ
Mintz
D H
DH
Starzl
T E
TE
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