Effects of graft-versus-host reaction on intrahepatic islet transplants

The use of donor-specific bone marrow transplantation might represent a valuable approach for the induction of hyporesponsiveness to concurrent allogeneic organ and tissue grafts. In this setting, the occurrence of subclinical forms of graft-versus-host reaction (GVHR) can seldom be formally ruled out. When systemic administration of donor-specific bone marrow is performed together with intraportal transplantation of islets of Langerhans, GVHR might damage the implanted islets through an innocent bystander mechanism. The liver is, in fact, a prominent target of GVHR, and islets are sensitive to the noxious effects of proinflammatory mediators, including selected cytokines produced during GVHR. A parent (Lewis) to F1 (Lewis x Brown Norway) splenocyte transfer model was used to induce GVHR in rats. Islets were also obtained from Lewis donors and implanted into F1 recipients to examine the effects of GVHR on islet function in the absence of rejection. Selected doses of splenocytes were infused in F1 recipients to induce GVHR. When 150 x 10(6) cells were administered, all recipients developed clinical lethal GVHR. When 100 x 10(6) or 80 x 10(6) cells were given, lethal GVHR was observed in 40 and 20% of the F1 animals, respectively. A transient clinical syndrome occurred in the remaining animals and spontaneously subsided; histological findings consistent with persistent low-grade GVHR were observed in these animals at the time of death several months after splenocyte inoculation. When simultaneous splenocyte infusions and islet grafts were performed in chemically diabetic animals, no adverse effect of either clinical or subclinical GVHR was observed on islet function. Blood glucose profiles were normal, as were intravenous glucose tolerance test profiles. In conclusion, GVHR does not seem to adversely influence function of islets of Langerhans implanted intrahepatically in this parent to F1 experimental model.