Abstract:

Objective To evaluate the effect and safty of islet transplantation after kidney transplantation for patients with type 2 diabetes mellitus（T2DM）and end-stage renal disease. Methods One case of islet transplantation was performed on a patient with T2DM complicated with chronic renal failure who had received kidney transplantation 3 months ago. The recipient was given exgenous insulin therapy with a dose of 1.26 U/（kg·d） before islet transplantation. The islets were transplanted into the liver through interna jugular vein transhepatic portal catheterization， as TIPS approach， the portal channel was established within the main portal vein， and the islets were slowly injected into the recipient's liver at a constant speed. Anti-CD25 monoclonal antibody was used as induction and a combination ofetanercept， mycophenolate mofetil and tacrolimus were used as maintenance immunosuppression therapy. Insulin dose， the level of blood glucose， C-peptide and the value of HbA1c were observed.Results Blood glucose was normal soon afteroperation， and the exogenous insulin was suspended. The fasting blood glucose was 4.8 ~ 8.5 mmol/L and the postprandial blood glucose was 6.9 ~ 15.1 mmol/L within the first week after operation. The total amount of exogenous insulin decreased by 50.14% compared with that before operation. The value of HbA1c was 6.3% within the first week after operation（the level of HbA1c was 6.6% before operation）. The fasting and postprandial C-peptide and insulin levels increased after operation. On the 7th day after operation， insulin and C-peptide release tests were performed. The results showed that the function of transplanted islets was partially restored, and insulin secretion was rhythmic. Conclusion Islet transplantation is an effective treatment for T2DM patients with ESRD after kidney transplantation.

Key words:

Islet transplantation；Type 2 , diabetes mellitus； , Immunosuppression

摘要：

目的 探讨肾移植后行胰岛移植治疗 2 型糖尿病（type 2 diabetes mellitus，T2DM）的安全性及有效性。方法 1 例慢性肾功能衰竭合并 T2DM 的患者在肾移植术后 3 个月行胰岛移植治疗。患者在移植前依赖胰岛素治疗，用量为 1.26 U/（kg·d）。采用 TIPS 入路手术 ：经颈内静脉插入穿刺导管，通过肝右静脉，在肝实质内穿刺门静脉右支，建立门体通道，置管入门静脉主干，将移植的胰岛细胞缓慢注入受者肝脏中。免疫诱导应用巴利昔单抗，联合依那西普。术后免疫抑制方案继续应用他克莫司、吗替麦考酚酯。术后监测血糖、糖化血红蛋白、胰岛素功能系列、以及外源胰岛素用量等。结果 术后当日血糖正常，暂停外源胰岛素，术后 1 周空腹血糖 4.8 ～ 8.5 mmol/L，餐后血糖 6.9 ～ 15.1 mmol/L，术后 1 周外源胰岛素总量较术前下降了 50.14%。术后 1 周受者糖化血红蛋白为 6.3 %（术前为 6.6%）。术后空腹及餐后 C 肽及胰岛素水平较术前均有所增长。术后 1 周行胰岛素释放及 C 肽释放试验结果提示移植胰岛功能部分恢复，胰岛素分泌有节律。结论 肾移植后胰岛移植对胰岛素依赖的 2 型糖尿病是一种有效且安全的治疗方式。 

关键词:

胰岛移植 ；2 型糖尿病 ； 免疫抑制剂 ,