Transplantation of Pancreatic Islets Into the Omentum Using a Biocompatible Plasma-Thrombin Gel: First Experience at the Institute for Clinical and Experimental Medicine in Prague
Language English Country United States Media print-electronic
Document type Journal Article
PubMed
35227510
DOI
10.1016/j.transproceed.2021.11.037
PII: S0041-1345(22)00089-6
Knihovny.cz E-resources
- MeSH
- Biomedical Research * MeSH
- C-Peptide MeSH
- Diabetes Mellitus, Type 1 * drug therapy surgery MeSH
- Hypoglycemia * drug therapy MeSH
- Hypoglycemic Agents therapeutic use MeSH
- Insulin therapeutic use MeSH
- Blood Glucose MeSH
- Islets of Langerhans * MeSH
- Humans MeSH
- Omentum surgery MeSH
- Islets of Langerhans Transplantation * adverse effects methods MeSH
- Thrombin therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Names of Substances
- C-Peptide MeSH
- Hypoglycemic Agents MeSH
- Insulin MeSH
- Blood Glucose MeSH
- Thrombin MeSH
BACKGROUND: Islet transplantation represents an established therapeutic option for people with type 1 diabetes who have hypoglycemia unawareness syndrome and frequent problematic hypoglycemic episodes when other methods comprising diabetes education and use of technological support fail. Because the current standard method of islet infusion into the liver has some limitations, novel approaches are under investigation. METHODS: We report our first results with 2 cases of islet transplantation into an omental pouch using a biocompatible plasma-fibrin gel. The recipients received 12,350 and 5,350 islet equivalents per kilogram that were mixed with autologous plasma, seeded during a laparoscopic procedure on the omentum, overlaid with human thrombin solution, and fixed by flapping the omentum over. RESULTS: During a 9-month follow-up, neither patient experienced any moderate or severe hypoglycemia. Their glucose control significantly improved, insulin dose decreased by approximately 50%, and C-peptide at 1 year was 0.22 and 0.14 pmol/mL, respectively. The postoperative course was uneventful, but C-peptide production in the first patient progressively declined at 1 year and hypoglycemic episodes recurred. CONCLUSIONS: Though the results for these first 2 cases are not fully satisfactory, we have demonstrated the feasibility, safety, and ability of this novel method to restore insulin production. Further refinements to improve immediate islet survival seem necessary.
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