Successful islet transplantation from a single pancreas harvested from a young, low-BMI, non-heart-beating cadaver.
BACKGROUND
Young donors, donors with low body mass index (BMI), and non-heart-beating (NHB) donors are considered nonideal for islet transplantation. In this report, we successfully used a pancreas from a young, low-BMI, NHB donor for islet transplantation.


METHODS
The donor was a 15-year-old adolescent boy whose cause of death was rupture of a primary brain tumor. According to Japanese regulations, his pancreas was procured after cardiac arrest. Warm ischemic time was 3 minutes and cold ischemic time was 300 minutes. The pancreas was digested by the automated method of Ricordi, followed by purification using continuous Euro-Ficoll gradients on a Cobe 2991 device. The recipient was a 35-year-old woman with unstable type 1 diabetes mellitus. Her pretransplant C-peptide level was null. She suffered frequent hypoglycemic unawareness. Her pretransplant M value, which is a good marker for glucose instability, was 125. Islet yield was 252,816 IEQ. There were no signs of contamination. Viability of islets assessed by FDA/PI staining was 83%. Stimulation index was 2.7.


RESULTS
The patient received 5160 IEQ/kg of islets via the portal vein under local anesthesia. There were no transplant-related complications. Although she required minimal exogenous insulin, her C-peptide level increased to 0.7 ng/mL at postoperative day (POD) 14. Her M value at POD 15 to 19 decreased dramatically to 23.6, indicating good glycemic control. At 3 months posttransplant, episodes of hypoglycemia disappeared.


CONCLUSIONS
Although an additional transplant is mandatory to wean patients from insulin, this case shows the possibility of using marginal donors, such as a young, low-BMI, NHB donor, for pancreas islet transplantation.
Goto
T
T
Division of Gastroenterological Surgery, Graduate School of Medicine, Kobe University, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
Tanioka
Y
Y
Sakai
T
T
Matsumoto
I
I
Kakinoki
K
K
Tanaka
T
T
Li
S
S
Yoshikawa
T
T
Fujino
Y
Y
Suzuki
Y
Y
Kuroda
Y
Y
D000293:Adolescent; D001786:Blood Glucose / Q000378:metabolism; D001926:Brain Death; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery*; D006323:Heart Arrest; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D008297:Male; D019188:Organ Preservation Solutions; D010180:Pancreatectomy; D020858:Tissue and Organ Harvesting / Q000379:methods*; D016896:Treatment Outcome
D001786:Blood Glucose; D019188:Organ Preservation Solutions