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Islet yield remains a problem in islet autotransplantation
Charles P Morrison1, Simon A Wemyss-Holden, Ashley R Dennison
1University of Adelaide, Department of Surgery, The Queen Elizabeth Hospital, Woodville Road, Woodville, SA 5011 Australia.
Archives of Surgery (Chicago, Ill. : 1960)
|January 31, 2002
Summary
Surgical resection for chronic pancreatitis can cause type 1 diabetes. Islet autotransplantation aims to cure this, but success depends on transplanted islet mass. Optimizing islet isolation, especially reducing warm ischemic time, is crucial for insulin independence.
Area of Science:
- Endocrinology
- Gastroenterology
- Transplantation Surgery
Background:
- Chronic pancreatitis pain often requires surgical resection.
- Surgical resection can lead to iatrogenic type 1 diabetes mellitus.
- Islet cell autotransplantation is a potential treatment for iatrogenic diabetes.
Purpose of the Study:
- To review factors influencing functional islet mass for transplantation.
- To identify key areas for optimizing islet isolation techniques.
- To enhance the success rate of insulin independence after islet autotransplantation.
Main Methods:
- Systematic review of peer-reviewed articles from MEDLINE (1966-present).
- Analysis of original articles and reviews, focusing on level 2 and 3 evidence.
- Extraction and synthesis of data on islet isolation and transplantation outcomes.
Main Results:
- Improvements in collagenase, purification, and reduced cold ischemic times enhance islet yield.
- Optimizing all stages of islet isolation is necessary.
- Increasing the proportion of viable islets in the isolate is critical, especially in chronic pancreatitis.
Conclusions:
- Reducing warm ischemic time may significantly improve insulin independence rates.
- Further optimization of islet isolation processes is needed for consistent clinical success.
- Functional islet mass is the primary determinant of successful islet autotransplantation outcomes.