Abstract
Isolated pancreatic islet transplantation has been proposed as a possible way of treating diabetes, but despite extensive experimental research, successful clinical transplantation remains elusive. A major problem has been the isolation of sufficient viable islet tissue for transplantation, especially from the human pancreas. It is possible to improve the yield of islet tissue by omitting purification steps, and unpurified dispersed pancreas has been successfully transplanted experimentally. However, attempts to apply the same technique clinically have been unsuccessful and have produced unacceptable complications. There is evidence that exocrine contamination may impair the implantation of islet tissue when transplanted to restricted sites, such as the kidney capsule. Yet, complete purification of islet tissue is probably not necessary for safe transplantation with adequate implantation of tissue in sites such as the spleen or liver. Exocrine tissue may be more immunogenic than islet tissue, and complete purification may have advantages for the prevention of rejection.
Similar content being viewed by others
References
Alejandro R, Cutfield RG, Shienvold FL, Polonsky KS, Noel J, Olson L, Dillberger J, Miller J, Mintz DH (1986) Natural history of intrahepatic canine islet cell autografts. J Clin Invest 78: 1339–1348
Ballinger WF, Lacy PE (1972) Transplantation of intact pancreatic islets in rats. Surgery 72: 175–186
Cameron JL, Mehigan DG, Harrington DP, Zuidema GD (1980) Metabolic studies following intrahepatic autotransplantation of pancreatic islet grafts. Surgery 87: 397–400
Cameron JL, Mehigan DG, Broe PJ, Zuidema GD (1981) Distal pancreatectomy and islet autotransplantation for chronic pancreatitis. Ann Surg 193: 312–317
Child CG, Frey CJ, Fry WJ (1969) A reappraisal of removal of ninety-five per cent of the distal portion of the pancreas. Surg Gynecol Obstet 129: 49–56
Dobroschke J, Schwemmle K, Langhoff G, Laube H, Bretzel RG, Federlin K (1978) Autotransplantation von Langerhans'schen Inseln nach totaler Duodenopancreatektomie bei einem Patienten mit chronischer Pankreatitis. Dtsch Med Wochenschr 103: 1905–1910
DuToit DF, Reece-Smith H, McShane P, Denton T, Morris PJ (1982) Effect of cyclosporin A on allotransplanted pancreatic fragments to the spleen of totally pancreatectomised dogs. Transplantation 33: 302–307
Faustman D, Hauptfeld V, Lacy P, Davie J (1981) Prolongation of murine islet allograft survival by pretreatment of islets with antibody directed to Ia determinants. Proc Natl Acad Sci USA 78: 5156–5159
Faustman DL, Steinman RM, Gebel HM, Hauptfeld V, Davie JM, Lacy PE (1984) Prevention of rejection of murine islet allografts by pretreatment with anti-dendritic cell antibody. Proc Natl Acad Sci USA 81: 3864–3868
Finke EH, Lacy PE, Ono J (1979) Use of reflected green light for specific identification of islets in vitro after collagenase isolation. Diabetes 28: 612–613
Gotoh M, Maki T, Porter J, Satomi S, Monaco AP (1986) Effect of contaminating lymph nodes, ductal and vascular tissue, and exocrine tissue on the survival of purified pancreatic islet allografts. Transplant Proc 18: 1848–1850
Gray DWR, Warnock GL, Sutton R, Peters M, McShane P, Morris PJ (1986) Successful autotransplantation of isolated islets of Langerhans in the cynomolgus monkey. Br J Surg 73: 850–853
Gray DW, Gohde W, Carter N, Heiden T, Morris PJ (1989) Separation of pancreatic islets by fluorescence activated sorting. Diabetes 38 [Suppl 1]: 133–135
Gray DW, Sutton R, McShane P, Peters M, Morris PJ (1988) Exocrine contamination impairs implantation of islets transplanted beneath the kidney capsule. J Surg Res 45: 432–442
Hanson SL, Sutherland DE, Field MJ, Rabe F, Najarian JS (1981) Comparison of techniques for pancreatic islet transplantation in dogs. Surg Forum 32: 383–385
Hellman B (1959) Actual distribution of the number and volume of the islets of Langerhans in different size classes in nondiabetic humans of varying ages. Nature 184: 1498–1499
Hesse UJ, Sutherland DE, Gores PF, Sitges-Serra A, Najarian JS (1986) Comparison of splenic and renal subcapsular islet autografting in dogs. Transplantation 41: 271–274
Hinshaw DB, Jolley WB, Knierim KH, Hinshaw DB (1981) New nonenzymatic method for the isolation of functional pancreatic islets. Surg Forum 32: 381–383
Jolley WB, Knierim K, Hinshaw DB, Ham JM, Hinshaw DB (1982) Successful allografts of pancreatic islets in diabetic rabbits after donor-specific blood transfusion and antilymphocyte serum treatment. Transplant Proc 14: 413–414
Kolb E, Largiader F (1980) Clinical islet transplantation. Transplant Proc 12 [Suppl 2]: 205–207
Kolb E, Ruckert R, Largiader F (1977) Intraportal and intrasplenic autotransplantation of pancreatic islets in the dog. Eur Surg Res 9: 419–426
Kretschmer GJ, Sutherland DE, Matas AJ, Cain TL, Najarian JS (1977) Autotransplantation of pancreatic islets without separation of exocrine and endocrine tissue in totally pancreatectomized dogs. Surgery 82: 74–81
Lacy PE, Kostianovsky M (1967) Method for the isolation of intact islets of Langerhans from the rat pancreas. Diabetes 16: 35–39
Mehigan DG, Bell WR, Zuidema GD, Eggleston JC, Cameron JL (1980) Disseminated intravascular coagulation and portal hypertension following pancreatic islet autotransplantation. Ann Surg 191: 287–293
Mehigan DG, Zuidema GD, Eggleston JC, Cameron JL (1980) Pancreatic islet autotransplantation: results in dogs with chronic duct ligation. Am J Surg 139: 170–174
Mirkovitch V, Campiche M (1977) Absence of diabetes in dogs after total pancreatectomy and intrasplenic autotransplantation of pancreatic tissue. Transplant Proc 9: 321–323
Moskalewski S (1965) Isolation and culture of the islets of Langerhans of the guinea pig. Gen Comp Endocrinol 5: 342–353
Muller-Ruchholtz W, Leyhausen G, Petersen P, Schubert G, Ulrichs K (1987) A simple methodological principle for large scale extraction and purification of collagenase-digested islets. Transplant Proc 19: 911–915
Najarian JS, Sutherland DE, Matas AJ, Steffes MW, Simmons RL, Goetz FC (1977) Human islet transplantation: a preliminary report. Transplant Proc 9: 233–236
Najarian JS, Sutherland DE, Baumgartner D, Burke B, Rynasiewicz J, Matas AJ, Goetz FC (1980) Total or near total pancreatectomy and islet transplantation for treatment of chronic pancreatitis. Ann Surg 192: 526–542
Rajotte RV, Kneteman NM, Warnock GL, Procyshyn AW (1986) Long-term normoglycemia in pancreatectomized dogs transplanted with frozen/thawed pancreatic islets. Cryobiology 23: 214–221
Scharp DW, Murphy JJ, Newton WT, Ballinger WF, Lacy PE (1975) Transplantation of islets of Langerhans in diabetic rhesus monkeys. Surgery 77: 100–105
Steiniger B, Klempnauer J, Wonigeit K (1985) Altered distribution of class I and class II MHC antigens during acute pancreas allograft rejection in the rat. Transplantation 40: 234–239
Sun AM, Coddling JA, Haist RE (1974) A study of glucose tolerance and insulin response in partially depancreatectomised dogs. Diabetes 23: 424–432
Sutherland DE (1981) Pancreas and islet transplantation. II. Clinical trials. Diabetologia 20: 435–450
Sutherland DE, Steffes MW, Bauer GE, McManus D, Noe BD, Najarian JS (1974) Isolation of human and porcine islets of Langerhans and islet transplantation in pigs. J Surg Res 16: 102–111
Sutherland DE, Matas AJ, Goetz FC, Najarian JS (1980) Transplantation of dispersed pancreatic islet tissue in humans: autografts and allografts. Diabetes 29 [Suppl 1]: 31–44
Toledo-Pereyra LH, Bandlien KO, Gordon DA, Mackenzie GH, Reyman TA (1984) Renal subcapsular islet cell transplantation. Diabetes 33: 910–914
Traverso LW, Gomez RR (1982) Hemodynamic measurements after administration of aprotinin and/or heparin during pancreatic cell autotransplantation in the dog, pig and monkey. Ann Surg 195: 479–485
Tze WJ, Tai J (1984) Intracerebral allotransplantation of purified pancreatic endocrine cells and pancreatic islets in diabetic rats. Transplantation 38: 107–111
Valente U, Ferro M, Campisi C, Cataldi L, Traverso C, Fontana I, DeRosa E, Cama A, Tosatti E (1980) Report of clinical cases of islet autotransplantation. Transplant Proc 12 [Suppl 2]: 202–204
Author information
Authors and Affiliations
About this article
Cite this article
Gray, D.W.R. The role of exocrine tissue in pancreatic islet transplantation. Transplant Int 2, 41–45 (1989). https://doi.org/10.1007/BF02425972
Issue Date:
DOI: https://doi.org/10.1007/BF02425972