title: Intraportal islet transplantation: the impact of the liver microenvironment.
abstract: The portal vein remains the preferred site for pancreatic islet transplantation due to its easy access and low morbidity. However, despite great progress in isolation and transplantation protocols over the past few years, it is still associated with the early loss of some 50-70% of transplanted islets. The complex liver microenvironment itself presumably plays an important role in this loss. The present review focuses on the specifics of the liver microenvironment, notably the localized hepatic ischemia/reperfusion injury following transplantation, the low oxygenation of the portal vein, the instant blood-mediated inflammatory reaction, the endogenous liver immune system, and the gut-liver axis, and how they can each have an impact on the transplanted islets. It identifies the potential, or already applied, clinical interventions for improving intraportal islet survival, and pinpoints those promising areas still lacking preclinical research. Future interventions on clinical intraportal islet transplantation need to take into account the global context of the liver microenvironment, with multi-point interventions being most likely to improve early islet survival and engraftment.
authors.affiliation: Hepatology and Transplantation Laboratory, Department of Surgery, Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Divisions of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Vaihere
authors.initials: V
authors.lastname: Delaune
authors.affiliation: Divisions of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.|Cell Transplantation Laboratory, Department of Surgery, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
authors.affiliation: Hepatology and Transplantation Laboratory, Department of Surgery, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Lacotte
authors.affiliation: Hepatology and Transplantation Laboratory, Department of Surgery, Faculty of Medicine, University of Geneva, Geneva, Switzerland.|Divisions of Abdominal and Transplantation Surgery, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
mesh_terms: D000818:Animals; D060833:Cellular Microenvironment; D000069196:Gastrointestinal Microbiome; D006085:Graft Survival; D006801:Humans; D007249:Inflammation / Q000209:etiology / Q000473:pathology; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000379:methods*; D008099:Liver / Q000276:immunology / Q000293:injuries / Q000601:surgery; D011169:Portal Vein; D015427:Reperfusion Injury / Q000209:etiology / Q000473:pathology
keywords: gut-liver axis; instant blood-mediated inflammatory reaction; ischemia/reperfusion; islet transplantation; liver microenvironment