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Transplantation of islet cells of the pancreas: procedure, forecast
Last reviewed: 20.11.2021
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Transplantation of islet cells of the pancreas has theoretical advantages in comparison with the whole organ transplantation: the procedure is less invasive, the islets can be stored in cryopreserved, which makes it possible to optimize the transplantation time. Nevertheless, the procedure is too new to talk about the benefits, but the continuous improvement of the methodology contributes to increasing the chances of success. The disadvantages are that transplanted glucagon-secreting a-cells do not function (which may lead to hypoglycemia) and several glands are required to obtain islet cells for one patient (which exacerbates the discrepancy between supply and demand and the limit of application of the procedure). At the same time, it has been shown that islet cell transplantation helps maintain normal blood sugar in patients who need total pancreatectomy due to pain in chronic pancreatitis. Indications for surgery are the same as for transplantation of the entire pancreas. Simultaneous transplantation of islet cells and kidneys can be a very useful operation after the technology improves.
Procedure of transplantation of islet cells of the pancreas
The pancreas is removed from the donor corpses with the death of the brain; perfusion of collagenase through the pancreatic duct is performed to separate the pancreatic islets from the pancreatic tissue. The purified fraction of islet cells is inserted transdermally into the portal vein. Ostrovkovye cells move to the hepatic sinuses, where the insulin settles and secrete.
The results are better when 2 or 3 infusions of islet cells are carried out from 2 dead donors, followed by the appointment of immunosuppressive therapy, including antibodies to the IL-2 receptor, monoclonal antibodies (daclizumab), tacrolimus, sirolimus; glucocorticoids do not apply. Immunosuppressive therapy should continue throughout life or until island cells cease to function. Rejection is difficult to detect, but it can be diagnosed by a violation of the balance of glucose in the blood; treatment of rejection is not established. Complications during the procedure include bleeding during percutaneous puncture of the liver, portal vein thrombosis, portal hypertension.
With successful islet cell transplantation, short-term normoglycemia is maintained, but long-term results are not known; To achieve long-term independence from insulin, additional islet cells are necessary.