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Histologic graft assessment after clinical islet transplantation

Isse, Kumiko
Demetris, Anthony J.
Dinyari, Parastoo
Koh, Angela
Imes, Sharleen
Kin, Tatsuya
Emamaullee, Juliet
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Published in Transplantation. 2009, vol. 88, no. 11, p. 1286-1293
Abstract BACKGROUND: An accurate monitoring would help understanding the fate of islet grafts after transplantation. METHODS: This work assessed the feasibility of needle biopsy monitoring after intraportal islet transplantation (n=16), and islet graft morphology was studied with the addition of autopsy samples (n=2). Pancreas autopsy samples from two nondiabetic individuals were used as control. RESULTS: Islet tissue was found in five needle samples (31%). Sampling success was related to size (100% sampling for the four biopsies of 1.8 cm in length or higher, P ≤ 0.01). Mild liver abnormalities included localized steatosis (n=8), mild nodular regenerative hyperplasia and mild portal venopathy (n=3), and hepatocyte swelling (n=2). Endocrine cell composition and distribution were similar between islet grafts and normal islets within the native pancreas. There was no or minimal immune cell infiltrate in patients on and off exogenous insulin, including two patients with ongoing negative metabolic events (increasing HbA1c or insulin requirement). The infiltrate was mainly composed of CD4- and CD8-positive cells. CONCLUSION: This study demonstrates that needle biopsy is feasible after clinical islet transplantation but with a limited practical value because of its low islet sampling rate using current sampling and analysis methods. Both biopsy and autopsy samples demonstrated the well-preserved islet endocrine composition after transplantation and the presence of focal areas of steatosis. Islet grafts showed no or minimal immune cell infiltration, even in the case of ongoing islet loss. On the basis of the findings, possible reasons for allograft islet loss are discussed.
Keywords AdultAutopsy*Biopsy, NeedleCase-Control StudiesDiabetes Mellitus, Type 1/immunology/pathology/*surgeryFeasibility StudiesFemaleGraft Rejection/immunology/pathologyHumansIslets of Langerhans/immunology/*pathology/*surgery*Islets of Langerhans Transplantation/adverse effectsLiver/immunology/*pathology/*surgeryMaleMiddle AgedPredictive Value of TestsProspective StudiesTime FactorsTransplantation, HomologousUltrasonography, Interventional
PMID: 19996928
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Research group Transplantation et hépatologie (905)
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TOSO, Christian et al. Histologic graft assessment after clinical islet transplantation. In: Transplantation, 2009, vol. 88, n° 11, p. 1286-1293. doi: 10.1097/TP.0b013e3181bc06b0 https://archive-ouverte.unige.ch/unige:20130

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Deposited on : 2012-04-23

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