Islet vs. pancreas transplantation in Brazil: Defining criteria for pancreas allocation decision

Sá, Gustavo Pilotto Domingues; Sogayar, Mari Cleide; Eliaschewitz, Freddy Goldberg; Genzini, Tércio; Letrinta, Renato Ferrari; Onari, Elton Shinji; Mantovani, Marta Sílvia Maria; Labriola, Letícia; Matos, Délcio; Lopes-Filho, Gaspar Jesus; Gonzalez, A.M.; Mares-Guia, Thiago Rennó dos

doi:10.4161/isl.3.6.17908

Cited by 4 publications

(1 citation statement)

References 38 publications

(42 reference statements)

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“…The study by Sá and cols. (53) reinforced the importance of the donor BMI as a defining parameter for successful islet isolation and established this variable as a potential pancreas alloca-Arch Endocrinol Metab. 2015;59/2 tion criterion for pancreatic islet transplantation in Brazil.…”

Section: Islet Transplantation and The Current Status Of This Procedumentioning

confidence: 93%

Human pancreatic islet transplantation: an update and description of the establishment of a pancreatic islet isolation laboratory

Rheinheimer

Bauer

Silveiro

et al. 2015

Arch. Endocrinol. Metab.

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Type 1 diabetes mellitus (T1DM) is associated with chronic complications that lead to high morbidity and mortality rates in young adults of productive age. Intensive insulin therapy has been able to reduce the likelihood of the development of chronic diabetes complications. However, this treatment is still associated with an increased incidence of hypoglycemia. In patients with "brittle T1DM" , who have severe hypoglycemia without adrenergic symptoms (hypoglycemia unawareness), islet transplantation may be a therapeutic option to restore both insulin secretion and hypoglycemic perception. The Edmonton group demonstrated that most patients who received islet infusions from more than one donor and were treated with steroid-free immunosuppressive drugs displayed a considerable decline in the initial insulin independence rates at eight years following the transplantation, but showed permanent C-peptide secretion, which facilitated glycemic control and protected patients against hypoglycemic episodes. Recently, data published by the Collaborative Islet Transplant Registry (CITR) has revealed that approximately 50% of the patients who undergo islet transplantation are insulin independent after a 3-year follow-up. Therefore, islet transplantation is able to successfully decrease plasma glucose and HbA1c levels, the occurrence of severe hypoglycemia, and improve patient quality of life. The goal of this paper was to review the human islet isolation and transplantation processes, and to describe the establishment of a human islet isolation laboratory at the Endocrine Division of the Hospital de Clínicas de Porto Alegre -Rio Grande do Sul, Brazil. Arch Endocrinol Metab. 2015;59(2):161-70

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Section: Islet Transplantation and The Current Status Of This Procedumentioning

confidence: 93%

Human pancreatic islet transplantation: an update and description of the establishment of a pancreatic islet isolation laboratory

Rheinheimer

Bauer

Silveiro

et al. 2015

Arch. Endocrinol. Metab.

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Treating diabetes with islet transplantation: Lessons learnt from the Nordic network for clinical islet transplantation

Zur‐Mühlen

Scholz

Hellman

et al. 2020

Transplantation, Bioengineering, and Regeneration of the Endocrine Pancreas

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The allocation of pancreas allografts on donor age and duration of intensive care unit stay: the experience of the North Italy Transplant program

Cardillo

Nano²,

Fazio

et al. 2014

Transpl Int

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SummaryStarting in 2011, the North Italy Transplant program (NITp) has based on the allocation of pancreas allografts on donor age and duration of intensive care unit (ICU) stay, but not on donor weight or BMI. We analyzed the detailed allocation protocols of all NITp pancreas donors (2011-2012; n = 433). Outcome measures included donor characteristics and pancreas loss reasons during the allocation process. Twenty-three percent of the 433 pancreases offered for allocation were transplanted. Younger age, shorter ICU stay, traumatic brain death, and higher eGFR were predictors of pancreas transplant, either as vascularized organ or as islets. Among pancreas allografts offered to vascularized organ programs, 35% were indeed transplanted, and younger donor age was the only predictor of transplant. The most common reasons for pancreas withdrawal from the allocation process were donor-related factors. Among pancreas offered to islet programs, 48% were processed, but only 14.2% were indeed transplanted, with unsuccessful isolation being the most common reason for pancreas loss. Younger donor age and higher BMI were predictors of islet allograft transplant. The current allocation strategy has allowed an equal distribution of pancreas allografts between programs for either vascularized organ or islet transplant. The high rate of discarded organs remained an unresolved issue.

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Islet vs. pancreas transplantation in Brazil: Defining criteria for pancreas allocation decision

Abstract: These data reinforce the importance of the donor BMI as a defining parameter for successful islet isolation and establishes this variable as a potential pancreas allocation criterion in Brazil, where there is unequal competition for good quality organs between WOPT and PIT.

Cited by 4 publications

References 38 publications

Human pancreatic islet transplantation: an update and description of the establishment of a pancreatic islet isolation laboratory

Human pancreatic islet transplantation: an update and description of the establishment of a pancreatic islet isolation laboratory

Treating diabetes with islet transplantation: Lessons learnt from the Nordic network for clinical islet transplantation

The allocation of pancreas allografts on donor age and duration of intensive care unit stay: the experience of the North Italy Transplant program

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