Background: There is a recent focus on embolization of the portal vein by transplanted islets as a major cause of early graft loss. The resultant ischemia causes necrosis or apoptosis of cells within the liver. Thus, noninvasive assessment of the liver receiving the islet transplant is important to evaluate the status islet grafts.
Methods: This study used noninvasive magnetic resonance imaging (MRI) for assessment of the posttransplant ischemic liver. Syngeneic islets in streprozotocin-induced diabetic mice were used. MRI and morphological liver assessments were performed at 0, 2, and 28 days after transplantation. Histologic assessment of insulin, hypoxia induced factor 1-alpha, and apoptosis were undertaken at similar time points.
Results: Ischemic/necrotic regions in the liver were detected by MRI at 2 days but not at 28 days after transplantation and were confirmed histologically. Liver injury was quantified from high intensity areas on T2-weighted images. Insulin release peaked 2 days after transplantation.
Conclusion: Onset and reversal of liver ischemia due to intraportal islet transplantation are detectable using T2-weighted MRI. These changes coincide with periods of maximum insulin release likely due to partial islet destruction. We propose that MRI, as a noninvasive monitor of graft-related ischemia, may be useful in assessment of liver and islet engraftment after intraportal islet transplantation in a clinical setting.
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http://dx.doi.org/10.1097/TP.0b013e318199c7d2 | DOI Listing |
J Am Coll Surg
January 2025
Departments of Surgery, University of Minnesota Medical School Department of Pediatrics, University of Minnesota Medical School Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota.
Background: Total pancreatectomy and intraportal islet cell auto transplantation (TPIAT) is increasingly being offered to patients with refractory chronic pancreatitis. Understanding factors that impact islet function over time is critical.
Study Design: We evaluated factors associated with islet function over 12 years post TPIAT using mixed meal tolerance testing (MMTT).
Surg Innov
December 2024
LUMC Transplant Center, Leiden University Medical Center, Leiden, The Netherlands.
Background: Intraportal pancreatic islet transplantation is a treatment option for patients with severe beta cell failure and unstable glycemic control. However, this procedure is associated with loss of beta cells after intrahepatic transplantation. Islet delivery devices (IDDs) implanted at extrahepatic sites may support engraftment and improve survival of pancreatic islets.
View Article and Find Full Text PDFDiabetes
December 2024
Department of Medicine, Division of Endocrinology, Diabetes & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, U.S.A.
Transplanted islet functional β-cell mass is measured by the β-cell secretory capacity derived from the acute insulin response to glucose-potentiated arginine (AIRpot), however, data are limited beyond one-year post-transplant for individuals with type 1 diabetes. We evaluated changes in β-cell secretory capacity in a single-center longitudinal analysis and examined relationships with measures of islet cell hormone metabolism and clinical measures of graft function (mixed-meal tolerance test [MMTT] C-peptide, BETA-2 score, and continuous glucose monitoring [CGM]). Eleven individuals received purified human pancreatic islets over one or two intra-portal infusions to achieve insulin-independence and were followed over a median (IQR) 6 (5-7) years.
View Article and Find Full Text PDFFront Transplant
November 2024
Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
Islet transplantation (ITx) is an effective means to restore physiologic glycemic regulation in those living with type 1 diabetes; however, there are a handful of barriers that prevent the broad application of this functionally curative procedure. The restricted cell supply, requisite for life-long toxic immunosuppression, and significant immediate and gradual graft attrition limits the procedure to only those living with brittle diabetes. While intraportal ITx is the primary clinical site, portal vein-specific factors including low oxygen tension and the instant blood-mediated inflammatory reaction are detrimental to initial engraftment and long-term function.
View Article and Find Full Text PDFIslets
December 2024
Clinical Research Unit and Working Group Experimental Diabetology and Islet Cell Biology, Medical Clinic and Polyclinic III, Center of Internal Medicine, Justus Liebig University, Gießen, Germany.
Background: Islet or β-cell transplantation is a therapeutical approach to substitute the insulin-producing cells which are abolished in type 1 diabetes mellitus. The shortage of human islets as well as the complicated and costly isolation process limit the application of these techniques in daily clinical practice. EndoC-βH is a human β-cell line that readily forms aggregates termed pseudoislets, providing an alternative to primary human islets or β-cells.
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