Islet transplantation using donors after cardiac death: Report of the Japan islet transplantation registry

Takuro Saito, Mitsukazu Gotoh, Susumu Satomi, Shinji Uemoto, Takashi Kenmochi, Toshinori Itoh, Yoshikazu Kuroda, Youichi Yasunami, Shnichi Matsumoto, Satoshi Teraoka

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background.: This report summarizes outcomes of islet transplantation employing donors after cardiac death (DCD) between 2004 and 2007 as reported to the Japan Islet Transplantation Registry. METHOD.: Sixty-five islet isolations were performed for 34 transplantations in 18 patients with insulin-dependent diabetes mellitus, including two patients who had prior kidney transplantation. All but one donor (64/65) was DCD at the time of harvesting. Results.: Factors influencing criteria for islet release included duration of low blood pressure of the donor, cold ischemic time, and usage of Kyoto solution for preservation. Multivariate analysis selected usage of Kyoto solution as most important. Of the 18 recipients, 8, 4, and 6 recipients received 1, 2, and 3 islet infusions, respectively. Overall graft survival defined as C-peptide level more than or equal to 0.3 ng/mL was 76.5%, 47.1%, and 33.6% at 1, 2, and 3 years, respectively, whereas corresponding graft survival after multiple transplantations was 100%, 80.0%, and 57.1%, respectively. All recipients remained free of severe hypoglycemia while three achieved insulin independence for 14, 79, and 215 days. HbA1c levels and requirement of exogenous insulin were significantly improved in all patients. Conclusion.: Islet transplantation employing DCD can ameliorate severe hypoglycemic episodes, significantly improve HbA1c levels, sustain significant levels of C-peptide, and achieve insulin independence after multiple transplantations. Thus, DCD can be an important resource for islet transplantation if used under strict releasing criteria and in multiple transplantations, particularly in countries where heart-beating donors are not readily available.

Original languageEnglish
Pages (from-to)740-747
Number of pages8
JournalTransplantation
Volume90
Issue number7
DOIs
Publication statusPublished - 15-10-2010

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Islets of Langerhans Transplantation
Registries
Japan
Tissue Donors
Transplantation
C-Peptide
Graft Survival
Insulin
Cold Ischemia
Blood Donors
Type 1 Diabetes Mellitus
Hypoglycemia
Hypoglycemic Agents
Kidney Transplantation
Hypotension
Multivariate Analysis

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Saito, Takuro ; Gotoh, Mitsukazu ; Satomi, Susumu ; Uemoto, Shinji ; Kenmochi, Takashi ; Itoh, Toshinori ; Kuroda, Yoshikazu ; Yasunami, Youichi ; Matsumoto, Shnichi ; Teraoka, Satoshi. / Islet transplantation using donors after cardiac death : Report of the Japan islet transplantation registry. In: Transplantation. 2010 ; Vol. 90, No. 7. pp. 740-747.
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abstract = "Background.: This report summarizes outcomes of islet transplantation employing donors after cardiac death (DCD) between 2004 and 2007 as reported to the Japan Islet Transplantation Registry. METHOD.: Sixty-five islet isolations were performed for 34 transplantations in 18 patients with insulin-dependent diabetes mellitus, including two patients who had prior kidney transplantation. All but one donor (64/65) was DCD at the time of harvesting. Results.: Factors influencing criteria for islet release included duration of low blood pressure of the donor, cold ischemic time, and usage of Kyoto solution for preservation. Multivariate analysis selected usage of Kyoto solution as most important. Of the 18 recipients, 8, 4, and 6 recipients received 1, 2, and 3 islet infusions, respectively. Overall graft survival defined as C-peptide level more than or equal to 0.3 ng/mL was 76.5{\%}, 47.1{\%}, and 33.6{\%} at 1, 2, and 3 years, respectively, whereas corresponding graft survival after multiple transplantations was 100{\%}, 80.0{\%}, and 57.1{\%}, respectively. All recipients remained free of severe hypoglycemia while three achieved insulin independence for 14, 79, and 215 days. HbA1c levels and requirement of exogenous insulin were significantly improved in all patients. Conclusion.: Islet transplantation employing DCD can ameliorate severe hypoglycemic episodes, significantly improve HbA1c levels, sustain significant levels of C-peptide, and achieve insulin independence after multiple transplantations. Thus, DCD can be an important resource for islet transplantation if used under strict releasing criteria and in multiple transplantations, particularly in countries where heart-beating donors are not readily available.",
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Saito, T, Gotoh, M, Satomi, S, Uemoto, S, Kenmochi, T, Itoh, T, Kuroda, Y, Yasunami, Y, Matsumoto, S & Teraoka, S 2010, 'Islet transplantation using donors after cardiac death: Report of the Japan islet transplantation registry', Transplantation, vol. 90, no. 7, pp. 740-747. https://doi.org/10.1097/TP.0b013e3181ecb044

Islet transplantation using donors after cardiac death : Report of the Japan islet transplantation registry. / Saito, Takuro; Gotoh, Mitsukazu; Satomi, Susumu; Uemoto, Shinji; Kenmochi, Takashi; Itoh, Toshinori; Kuroda, Yoshikazu; Yasunami, Youichi; Matsumoto, Shnichi; Teraoka, Satoshi.

In: Transplantation, Vol. 90, No. 7, 15.10.2010, p. 740-747.

Research output: Contribution to journalArticle

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T1 - Islet transplantation using donors after cardiac death

T2 - Report of the Japan islet transplantation registry

AU - Saito, Takuro

AU - Gotoh, Mitsukazu

AU - Satomi, Susumu

AU - Uemoto, Shinji

AU - Kenmochi, Takashi

AU - Itoh, Toshinori

AU - Kuroda, Yoshikazu

AU - Yasunami, Youichi

AU - Matsumoto, Shnichi

AU - Teraoka, Satoshi

PY - 2010/10/15

Y1 - 2010/10/15

N2 - Background.: This report summarizes outcomes of islet transplantation employing donors after cardiac death (DCD) between 2004 and 2007 as reported to the Japan Islet Transplantation Registry. METHOD.: Sixty-five islet isolations were performed for 34 transplantations in 18 patients with insulin-dependent diabetes mellitus, including two patients who had prior kidney transplantation. All but one donor (64/65) was DCD at the time of harvesting. Results.: Factors influencing criteria for islet release included duration of low blood pressure of the donor, cold ischemic time, and usage of Kyoto solution for preservation. Multivariate analysis selected usage of Kyoto solution as most important. Of the 18 recipients, 8, 4, and 6 recipients received 1, 2, and 3 islet infusions, respectively. Overall graft survival defined as C-peptide level more than or equal to 0.3 ng/mL was 76.5%, 47.1%, and 33.6% at 1, 2, and 3 years, respectively, whereas corresponding graft survival after multiple transplantations was 100%, 80.0%, and 57.1%, respectively. All recipients remained free of severe hypoglycemia while three achieved insulin independence for 14, 79, and 215 days. HbA1c levels and requirement of exogenous insulin were significantly improved in all patients. Conclusion.: Islet transplantation employing DCD can ameliorate severe hypoglycemic episodes, significantly improve HbA1c levels, sustain significant levels of C-peptide, and achieve insulin independence after multiple transplantations. Thus, DCD can be an important resource for islet transplantation if used under strict releasing criteria and in multiple transplantations, particularly in countries where heart-beating donors are not readily available.

AB - Background.: This report summarizes outcomes of islet transplantation employing donors after cardiac death (DCD) between 2004 and 2007 as reported to the Japan Islet Transplantation Registry. METHOD.: Sixty-five islet isolations were performed for 34 transplantations in 18 patients with insulin-dependent diabetes mellitus, including two patients who had prior kidney transplantation. All but one donor (64/65) was DCD at the time of harvesting. Results.: Factors influencing criteria for islet release included duration of low blood pressure of the donor, cold ischemic time, and usage of Kyoto solution for preservation. Multivariate analysis selected usage of Kyoto solution as most important. Of the 18 recipients, 8, 4, and 6 recipients received 1, 2, and 3 islet infusions, respectively. Overall graft survival defined as C-peptide level more than or equal to 0.3 ng/mL was 76.5%, 47.1%, and 33.6% at 1, 2, and 3 years, respectively, whereas corresponding graft survival after multiple transplantations was 100%, 80.0%, and 57.1%, respectively. All recipients remained free of severe hypoglycemia while three achieved insulin independence for 14, 79, and 215 days. HbA1c levels and requirement of exogenous insulin were significantly improved in all patients. Conclusion.: Islet transplantation employing DCD can ameliorate severe hypoglycemic episodes, significantly improve HbA1c levels, sustain significant levels of C-peptide, and achieve insulin independence after multiple transplantations. Thus, DCD can be an important resource for islet transplantation if used under strict releasing criteria and in multiple transplantations, particularly in countries where heart-beating donors are not readily available.

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