raffinose and Diabetes-Mellitus--Type-1

Celsior solution (CS), which has recently become available, that might theoretically offer a new means for improving graft preservation quality. The present prospective, randomized study was designed to evaluate the efficacy of CS compared with University of Wisconsin (UW) for pancreas allografts. Between January 2001 and January 2007, 88 patients underwent pancreatic transplantation, including the last 30 consecutive simultaneous pancreas kidney patients who were randomly assigned to either CS or UW. There was no case of graft thrombosis in either group. There were 2 cases of pancreatitis in the UW group compared with 1 in the CS group. No case of primary nonfunction occurred in either group. There were 2 cases of early duodenal stump fistulae in the CS group that required transplantectomy, whereas this complication was not observed in the UW group. Relaparotomy in the UW group was required in 3 cases due to infection and treated by close drainage that which, progressed to fatal sepsis in 1 patient. In the UW group with 6 months of follow-up, there were 12 patients insulin free. In the CS group, 6 patients underwent relaparotomy, 3 for transplantectomy and the others for intra-abdominal infection, which was fatal in 2 cases. In the CS group with 6 months of follow-up, there were 10 patients insulin free. Two patients died with functioning grafts. These results provided indirect evidence that CS solution is at least as safe as UW to mitigate postreperfusion graft edema and pancreatitis, as well as graft thrombosis.

Topics: Adenosine; Adult; Allopurinol; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Disaccharides; Electrolytes; Female; Glutamates; Glutathione; Histidine; Humans; Insulin; Kidney Transplantation; Male; Mannitol; Middle Aged; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Raffinose; Reperfusion Injury; Safety; Young Adult

Topics: Adenosine; Allopurinol; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Glutathione; Humans; Hypertonic Solutions; Insulin; Kidney Failure, Chronic; Kidney Transplantation; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Postoperative Complications; Raffinose; Retrospective Studies; Thrombosis

Islet transplantation has recently emerged as an effective therapy and potential cure for type 1 diabetes mellitus. Recent reports show that the two-layer method (TLM), which employs oxygenated perfluorochemical (PFC) and University of Wisconsin (UW) solution, is superior to simple cold storage in UW for pancreas preservation in islet transplantation. Moreover, we recently reported that islet yield was significantly higher in the ET-Kyoto solution with ulinastatin (MK)/PFC preservation solution compared with the UW/PFC preservation solution in the porcine model and that the advantages of MK solution are trypsin inhibition and less collagenase inhibition. In this study, we compared ulinastatin with another trypsin inhibitor, Pefabloc, in preservation solution for islet isolation. Islet yield before purification was higher in the MK/PFC group compared with the ET-Kyoto with Pefabloc (PK)/PFC group. The stimulation index was higher for the MK/PFC group than for the PK/PFC group. These data suggest that ET-Kyoto with ulinastatin was the better combination for pancreas preservation than ET-Kyoto with Pefabloc. Based on these data, we now use ET-Kyoto solution with ulinastatin for clinical islet transplantation.

Topics: Adenosine; Allopurinol; Animals; Cell Separation; Diabetes Mellitus, Type 1; Fluorocarbons; Gluconates; Glutathione; Glycoproteins; Hydroxyethyl Starch Derivatives; Insulin; Islets of Langerhans; Islets of Langerhans Transplantation; Organ Preservation; Organ Preservation Solutions; Phosphates; Raffinose; Sulfones; Swine; Trehalose; Trypsin Inhibitors

We investigated the effects of nicotinamide (NA) supplementation of the processing medium during islet isolation. One hundred and two human pancreata were processed for clinical transplantation after preservation either in the University of Wisconsin (UW) or using the two-layer method (TLM). Pancreata were then divided into four groups and retrospectively analyzed. Group I: UW preservation followed by processing without NA, Group II: UW preservation and processing with NA, Group III: TLM preservation without NA, Group IV: TLM preservation with NA. We observed a significant increase in islet yield in Group II (4343+/-348 IEQ/g) [mean+/-SEM], compared to Group I (2789+/-348 IEQ/g) (p=0.005). Similarly, a significant increase in islet yield was observed when NA was used in the processing of organs preserved with TLM (Group IV: 5538+/-413 vs. Group III: 3500+/-629; p=0.02). Furthermore islet yield was higher in Group IV than in Group II (p<0.05). The percentages of preparations that qualified for transplantation were 25, 47, 45, 69% in Groups I, II, III, IV, respectively. Addition of NA to the processing medium significantly improved islet yields in both the UW and TLM preservation protocols, allowing for a higher percentage of islet preparations to qualify for clinical transplantation.

Topics: Adenosine; Adult; Allopurinol; Cell Separation; Diabetes Mellitus, Type 1; Glutathione; Humans; Insulin; Islets of Langerhans; Islets of Langerhans Transplantation; Middle Aged; Niacinamide; Organ Preservation; Organ Preservation Solutions; Pancreas; Raffinose; Retrospective Studies

The use of Celsior solution for organ preservation has not been thoroughly studied in pancreas transplantation. The aim of this study was to compare University of Wisconsin and Celsior solutions for preservation of pancreas grafts.. From March 1995 to December 2005, 72 patients with type 1 diabetes underwent pancreas transplantation. There were 42 men and 30 women, with a mean age at transplantation of 38.1 +/- 7.5 years (range: 27 to 55 years), and a mean duration of diabetes of 22.5 +/- 6.6 years. Recipients were classified into two groups according to the preservation solution: (A) Celsior (n = 28, 38.9%) and (B) Wisconsin (n = 44, 61.1%).. The donor and recipient characteristics were similar in both groups. There were five cases of venous thrombosis in the Wisconsin group and two in the Celsior group (P = NS). The venous drainage technique in the former group was portocaval in 19 patients and portoiliac in 25; in the Celsior group, portocaval in 23 patients and portoiliac in five (P = .001). Enteric drainage was used in 19 patients from the Celsior group and 17 patients from the Wisconsin group (P = .01). Actuarial 2-year graft survival was 74.6% in the Wisconsin group and 77.4% in the Celsior group (P = NS).. No differences were observed in venous thrombosis between the two groups. The lower rate of venous thrombosis with the portocaval technique was related to the type of venous drainage rather than the type of preservation solution. Celsior solution may be considered as good as Wisconsin solution for pancreas transplantation.

Topics: Adenosine; Adolescent; Adult; Allopurinol; Diabetes Mellitus, Type 1; Disaccharides; Drainage; Electrolytes; Female; Glutamates; Glutathione; Histidine; Humans; Insulin; Male; Mannitol; Middle Aged; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Portacaval Shunt, Surgical; Raffinose; Retrospective Studies; Tissue Donors

Islet transplantation, though still in the experimental phase, is a therapeutic option that has opened new expectations for the control of diabetes mellitus. Initial results are encouraging for the significant advantages compared with whole pancreas transplantation for selected patients with type 1 diabetes mellitus, with or without kidney failure. However, the success of transplantation, both at centers with more experience and others with less, is limited by the difficulty in obtaining a suitable number of donors and by laboratory isolation techniques. Significant advances require changes in donor selection, perfusion, oxygenation, and transfer of the pancreas, and in the process of isolation, purification, and culture in the laboratory. Of the 32 pancreases sent to the islet isolation laboratory from different hospitals in Andalusia, a viable percentage of islets was finally available in 19. However, in only 4 (18%) procedures were the preparations considered optimal for implantation in 2 recipients.

Topics: Adenosine; Allopurinol; Diabetes Mellitus, Type 1; Glutathione; Humans; Insulin; Islets of Langerhans Transplantation; Organ Preservation Solutions; Pancreas; Patient Selection; Raffinose; Spain; Tissue and Organ Procurement; Tissue Donors

Topics: Adenosine; Allopurinol; Animals; Blood Glucose; Diabetes Mellitus, Type 1; Glucose; Glutathione; Insulin; Mannitol; Organ Preservation; Organ Preservation Solutions; Pancreas; Pancreas Transplantation; Pancreatectomy; Potassium Chloride; Procaine; Raffinose; Swine

Topics: Adenosine; Adult; Allopurinol; Amylases; Blood Glucose; Creatinine; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Duodenum; Glutathione; Histocompatibility Testing; Humans; Insulin; Kidney Failure, Chronic; Kidney Transplantation; Male; Organ Preservation; Organ Preservation Solutions; Pancreas Transplantation; Raffinose; Solutions; Spleen; Thrombosis; Tomography, X-Ray Computed; Transplantation, Homologous

Topics: Adenosine; Adult; Allopurinol; Blood Glucose; Child; Child, Preschool; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Glutathione; Humans; Immunosuppression Therapy; Insulin; Kidney Transplantation; Middle Aged; Organ Preservation; Organ Preservation Solutions; Pancreas Transplantation; Raffinose; Solutions; Tissue Donors; Urinary Bladder

Topics: Adenosine; Allopurinol; Cell Separation; Colony Count, Microbial; Diabetes Mellitus, Type 1; Drug Contamination; Glutathione; Humans; Insulin; Islets of Langerhans Transplantation; Organ Preservation Solutions; Pancreatic Neoplasms; Postoperative Complications; Pseudomonas; Raffinose; Solutions; Staphylococcus

Topics: Adenosine; Adult; Allopurinol; Cold Temperature; Diabetes Mellitus, Type 1; Diabetic Nephropathies; Female; Glutathione; Humans; Insulin; Kidney Transplantation; Male; Organ Preservation; Organ Preservation Solutions; Pancreas Transplantation; Raffinose; Retrospective Studies; Solutions; Transplantation, Homologous