Islet transplantation using donors after cardiac death: report of the Japan Islet Transplantation Registry.
BACKGROUND
This report summarizes outcomes of islet transplantation employing donors after cardiac death (DCD) between 2004 and 2007 as reported to the Japan Islet Transplantation Registry.


METHODS
Sixty-five islet isolations were performed for 34 transplantations in 18 patients with insulin-dependent diabetes mellitus, including two patients who had prior kidney transplantation. All but one donor (64/65) was DCD at the time of harvesting.


RESULTS
Factors influencing criteria for islet release included duration of low blood pressure of the donor, cold ischemic time, and usage of Kyoto solution for preservation. Multivariate analysis selected usage of Kyoto solution as most important. Of the 18 recipients, 8, 4, and 6 recipients received 1, 2, and 3 islet infusions, respectively. Overall graft survival defined as C-peptide level more than or equal to 0.3 ng/mL was 76.5%, 47.1%, and 33.6% at 1, 2, and 3 years, respectively, whereas corresponding graft survival after multiple transplantations was 100%, 80.0%, and 57.1%, respectively. All recipients remained free of severe hypoglycemia while three achieved insulin independence for 14, 79, and 215 days. HbA1c levels and requirement of exogenous insulin were significantly improved in all patients.


CONCLUSIONS
Islet transplantation employing DCD can ameliorate severe hypoglycemic episodes, significantly improve HbA1c levels, sustain significant levels of C-peptide, and achieve insulin independence after multiple transplantations. Thus, DCD can be an important resource for islet transplantation if used under strict releasing criteria and in multiple transplantations, particularly in countries where heart-beating donors are not readily available.
Saito
Takuro
T
Japanese Islet Transplant Registry, Fukushima Medical University, Fukushima City, Fukushima, Japan.
Gotoh
Mitsukazu
M
Satomi
Susumu
S
Uemoto
Shinji
S
Kenmochi
Takashi
T
Itoh
Toshinori
T
Kuroda
Yoshikazu
Y
Yasunami
Youichi
Y
Matsumoto
Shnichi
S
Teraoka
Satoshi
S
D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D002102:Cadaver; D002469:Cell Separation / Q000379:methods; D003643:Death; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006085:Graft Survival / Q000502:physiology*; D006339:Heart Rate; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000706:statistics & numerical data*; D007564:Japan; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation / Q000379:methods; D018579:Patient Selection; D012042:Registries; D012086:Reoperation / Q000706:statistics & numerical data; D014019:Tissue Donors; D055815:Young Adult
D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin