ET-Kyoto ductal injection and density-adjusted purification combined with potent anti-inflammatory strategy facilitated single-donor islet transplantation: case reports.
BACKGROUND
The necessity to use multiple donors for achieving insulin independence in clinical islet transplantation is still a major issue. We have developed a modified islet isolation method for non-heart-beating donors (Kyoto method) to significantly increase islet yield. In this study, we further modified the method for brain-dead donors and in addition, introduced a potent anti-inflammatory strategy aiming for single-donor islet transplantation.


METHODS
Two islet isolations used pancreatic ductal preservation with the modified Kyoto solution and a density-adjusted purification method. Anti-interleukin-1-beta antibody (Anakinra) and anti-tumor necrosis factor-alpha (Eternacept) were administered during and after transplantation. The efficacy of the islet transplantation was assessed by the insulin requirement and SUITO (Secretory Unit of Islet Transplant Objects) index, wherein a value of more than 26.0 seems to be associated with insulin independence.


RESULTS
Both isolated islet preparations met the criteria for transplantation. They were transplanted into two type 1 diabetic patients, both of whom became insulin independent with stable glycemic control. The average SUITO index within 1 month was 29.2 and 45.3.


CONCLUSIONS
The islet isolation method combined with a potent anti-inflammation strategy made it possible to achieve single-donor islet transplantation achieving a high SUITO index.
Matsumoto
S
S
Baylor All Saints Medical Center, Baylor Research Institute, Fort Worth, Texas 76104, USA. shinichm@baylorhealth.edu
Noguchi
H
H
Takita
M
M
Shimoda
M
M
Tamura
Y
Y
Olsen
G
G
Naziruddin
B
B
Onaca
N
N
Levy
M F
MF
D018501:Antirheumatic Agents / Q000627:therapeutic use; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005942:Gluconates / Q000627:therapeutic use; D006085:Graft Survival; D006801:Humans; D006895:Hydroxyethyl Starch Derivatives / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000378:metabolism*; D000078790:Insulin Secretion; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use; D007515:Islets of Langerhans / Q000166:cytology / Q000502:physiology; D016381:Islets of Langerhans Transplantation / Q000276:immunology / Q000379:methods*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D019188:Organ Preservation Solutions / Q000627:therapeutic use; D010710:Phosphates / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000379:methods; D014199:Trehalose / Q000627:therapeutic use
D018501:Antirheumatic Agents; C087059:ET-Kyoto solution; D005942:Gluconates; D006895:Hydroxyethyl Starch Derivatives; D007166:Immunosuppressive Agents; D007328:Insulin; D053590:Interleukin 1 Receptor Antagonist Protein; D019188:Organ Preservation Solutions; D010710:Phosphates; D014199:Trehalose; D009173:Mycophenolic Acid; D016559:Tacrolimus