Pancreatic islet cell transplantation

D. E R Sutherland, A. J. Matas, J. S. Najarian

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116 Scopus citations

Abstract

Although islet transplantation was originally conceived as a therapeutic approach to the patient with juvenile onset diabetes mellitus, the technique could also be applicable to patients after undergoing pancreatectomy for benign disease. Normal carbohydrate metabolism can be restored by the transplantation of immediately vascularized whole pancreas grafts; however, a high morbidity and mortality occurs due to the complications that arise from the enzymatic activity of the exocrine portion of the gland. Islets of Langerhans comprise only 1 to 2% of the adult pancreatic tissue and they can therefore be successfully transplanted without immediate vascularization. Currently, relatively pure preparations of islet cells can be achieved from human pancreas by using the collagenase digestion Ficoll gradient separation technique. Those preparations can synthesize insulin and glucagon and secrete the former after a glucose challenge. Sutherland and coworkers report ten allotransplants in seven insulin dependent diabetes mellitus patients and one case of autotransplantation of islets prepared from the excised pancreas in a case of chronic pancreatitis. Obviously, the most important aspect of this presentation is the establishment of the technical feasibility of islet transplant. Although no patients were cured of diabetes by transplantation of islets, a number of important observations can be made: that transplantation to the portal vein does not cause measurable hepatic dysfunction; portal pressure does not rise during infusions of islets; and rejection does not occur if there is good matching between donor and receptor. In summary, providing that some minor technical improvements can be achieved, transplantation of pancreatic islet cells is a relatively simple surgical procedure that certainly could play an invaluable role in the management of patients with endocrine pancreatic dysfunction. (Meeroff - Oklahoma City, Okla.)

Original languageEnglish (US)
Pages (from-to)365-382
Number of pages18
JournalSurgical Clinics of North America
Volume58
Issue number2
DOIs
StatePublished - 1978

Bibliographical note

Funding Information:
Supported by USPHS grants AM16566 and 19269 and by grants from the American Diabetes Association, Minnesota Chapter, and the Juvenile Diabetes Foundation

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