LONG-TERM DUCT-OCCLUDED SEGMENTAL PANCREATIC AUTOGRAFTS

Citation
Wj. Hawthorne et al., LONG-TERM DUCT-OCCLUDED SEGMENTAL PANCREATIC AUTOGRAFTS, Transplantation, 64(7), 1997, pp. 953-959
Citations number
41
Categorie Soggetti
Immunology,Surgery,Transplantation
Journal title
ISSN journal
00411337
Volume
64
Issue
7
Year of publication
1997
Pages
953 - 959
Database
ISI
SICI code
0041-1337(1997)64:7<953:LDSPA>2.0.ZU;2-6
Abstract
Background. Current insulin therapies for control of glucose metabolis m in patients with type I diabetes mellitus prevent major metabolic co nsequences of insulin deficiency, but none prevents or arrests longter m complications, In experimental models of canine diabetes, retinopath y, neuropathy, and nephropathy have been shown to develop within 5 yea rs, The aim of this study was to determine in a canine model whether g lucose control provided by segmental duct-occluded pancreas autografts could prevent the long-term complications of diabetes. Methods, Thirt y-five outbred mongrel dogs underwent segmental pancreas autotransplan tation with residual pancreatectomy, Follow-up over 5 years included e ndocrine, retinal fundus photography, fluorescein angiography, and ner ve conduction studies, At endpoint, analysis of organ specific changes was undertaken, Results, Long-term survival was achieved in 14 dogs f or 4 to 5 years and in 3 dogs for 3 to 5 years, Glycosylated hemoglobi n levels remained within normal limits, although response to glucose c hallenge was suboptimal, Fundus photography and fluorescein angiograph y demonstrated the absence of retinal vascular aneurisms, capillary le akage, and obliteration, Retinal digest showed no vascular changes and normal endothelial/pericyte ratios. Nerve conduction was normal, and histology of nerves revealed normal density of myelinated fibers and a bsence of intrafascicular vessels and glycogen deposits, with no chang e in spectrum of fiber diameters and ovoids, Renal histology revealed no evidence of nephropathy with normal glomerular basement membranes, Conclusions, We have demonstrated that duct-occluded segmental pancrea tic autografts are capable of providing satisfactory metabolic control for up to 5 years, thereby preventing development of the longterm mic rovascular complications of diabetes.