Logistics and Transplant Coordination Activity in the Gragil Swiss-French Multicenter Network of Islet Transplantation

Pancreas allocation in the era of islet transplantation

“…One answer to this problem is to develop multicenter networks for islet transplantation, in which one experienced centralized institution serves as the islet production facility for all centers participating to the network. The feasibility of the concept of remote islet isolation and transplantation was first demonstrated in 1997 by the report of the Portland‐Minneapolis collaboration in a setting of autologous islet transplantation [26], and has been reproduced and validated since, either in bilateral collaborative efforts or within the framework of multicenter networks [24,25,27,28].…”

“…The network is currently composed of eight university centers in France, namely Besançon, Grenoble, Lyon, Strasbourg, Dijon, Nancy, Marseille and Montpellier, and Geneva in Switzerland. The first patient was transplanted in 1999, and as of December 2004, islets isolated from pancreata harvested in Switzerland and three organ‐sharing regions in France have been transplanted into 52 patients throughout the network [27,29].…”

International workshop: islet transplantation without borders enabling islet transplantation in Greece with international collaboration and innovative technology

“…The GRAGIL Consortium is a multi‐center network in islet transplantation that was initiated in 1997 particularly to reduce costs associated with the infrastructure and operations of islet cell manufacturing . It also enabled centers to start islet transplantation without the need to build an infrastructure for islet cell manufacturing; hence, the network approach indirectly increases the donor and recipient population and enables to combine efforts in clinical trials.…”

Current status of islet cell transplantation

“…This will be of assistance in obtaining favorable outcomes in clinical islet transplantation trials, but also will improve distribution of human islet preparations to researchers at distant institutions without altering islet cell quality and physiology. In the GRAGIL (Group Rhin‐Rhone‐Alpes‐Geneve pour la Transplantation d'Ilots de Langerhans) experience, islets are transported by an ambulance to the remote transplant centers where they are transplanted within a few hours loaded in a syringe or infusion bag utilized for islet implantation [73, 74]. The University of California Islet Transplant Consortium reported shipping islets in the infusion bag to the remote centers within hours of isolation or after culture or cryopreserved prior to shipment [75, 76].…”

“…A 90% insulin‐free rate was reported in three centers including us (Edmonton and Minneapolis), while the overall insulin independence rate was 52%. Most type I diabetes recipients have significant benefits including improvements in glycemic control with normalization of HbA1c and substantial reduction of exogenous insulin requirements [6, 29, , 47, 57, 73, ]. Insulin independence is achieved by transplanting a sufficient number of islet mass (approximately 10,000 IEQ/kg of recipient's body weight) [33, 48, 113], Therefore, more than one donor pancreas per recipient is necessary for achieving insulin independence [29, 33, 112, 113].…”