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

(4 citation 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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“…The effectiveness of the islet isolation procedure is given by the yield in terms of iEQs (islet equivalents based on an islet of 150 µm diameter, thereby mathematically compensating for the islet volume). In a previous study of our group [ 10 ] we adopted as a good outcome for islet isolation yields the value of 200,000 IEQs, an intermediate number when compared with those found in the literature (Lakey and cols. [ 23 ] and Kim and cols.…”

Section: Discussionmentioning

confidence: 90%

“…[ 26 ] used 300,000 IEQs as a reference for a good islet isolation outcome). In the present study, we adopted yields of 100,000 IEQs as being satisfactory because during this period only 10% of the donors offered displayed BMI > 30 kg/m 2 and our previous study showed that pancreata from donors with BMI > 30 kg/m 2 yielded an average of 277,964 IEQs, while organs from donors with BMI < 30 kg/m 2 produced 104,874 IEQs (p < 0.001) [ 10 ]. In general, 68% of the pancreas accepted by our group resulted in yields of > 100.000 iEQs.…”

Section: Discussionmentioning

confidence: 99%

“…Human pancreata from adult heart-beating donors were harvested in accordance with Brazilian regulations and the local Institutional Ethical Committee (Protocol CAPPesq number 0742/02 / CONEP 9230). Criteria for acceptance or refusal of pancreata donors for islet isolation based on international criteria from worldwide islet transplantation reference centers were established in our laboratory [ 10 ] as follows: age below 18 above 60 years old, drug addiction, ethylism, infeccious diseases, seropositivity for Chagas disease, toxoplasmosis, rubella, syphilis, cytomegalovirus, hepatitis B and C and human immunodeficiency virus (HIV), neoplasia, hemodilution, history of diabetes, cold ischemia time of more than 12 h. The following criteria were also used, but exclusion was decided on a case-by-case basis: Intensive Care Unit (ICU) stay greater than nine days, amylase above 400 U/L, persistent hyperglycemia (200 mg/dL), cardiorespiratory arrest, serum creatinine 50% higher than the initial value, hemoglobin < 6.0 g/dL, unstable donor and macroscopic aspect of the pancreas. All data from organ donors were collected from those available in the form named “Information about the multiple organ donor” of the Brazilian Federal Government Transplantation Center (TC) ( https://www.gov.br/saude/pt-br/composicao/saes/snt ), which is responsible for coordinating the entire transplantation system in the State of São Paulo.…”

Section: Methodsmentioning

confidence: 99%

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Islet transplantation: overcoming the organ shortage

Mantovani

Gabanyi

Pantanali

et al. 2023

Diabetol Metab Syndr

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Background Type 1 diabetes mellitus (T1D) is a condition resulting from autoimmune destruction of pancreatic β cells, leading patients to require lifelong insulin therapy, which, most often, does not avoid the most common complications of this disease. Transplantation of isolated pancreatic islets from heart-beating organ donors is a promising alternative treatment for T1D, however, this approach is severely limited by the shortage of pancreata maintained under adequate conditions. Methods In order to analyze whether and how this problem could be overcome, we undertook a retrospective study from January 2007 to January 2010, evaluating the profile of brain-dead human pancreas donors offered to our Cell and Molecular Therapy NUCEL Center (www.usp.br/nucel) and the basis for organ refusal. Results During this time period, 558 pancreata were offered by the São Paulo State Transplantation Central, 512 of which were refused and 46 were accepted for islet isolation and transplantation. Due to the elevated number of refused organs, we decided to analyze the main reasons for refusal in order to evaluate the possibility of improving the organ acceptance rate. The data indicate that hyperglycemia, technical issues, age, positive serology and hyperamylasemia are the top five main causes for declination of a pancreas offer. Conclusions This study underlines the main reasons to decline a pancreas offer in Sao Paulo—Brazil and provides some guidance to ameliorate the rate of eligible pancreas donors, aiming at improving the islet isolation and transplantation outcome. Trial registration: Protocol CAPPesq number 0742/02/CONEP 9230.

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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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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

Islet transplantation: overcoming the organ shortage

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

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