临床胰岛移植的发展趋势

Trends in clinical islet transplantation

胰岛移植在近20年发展迅速,已逐渐成为1型糖尿病(type 1 diabetes mellitus,T1DM)临床治疗的理想方案之一。越来越多的临床证据证实,胰岛移植在胰岛素脱离或减量、低血糖发作的防治和糖尿病并发症的预防等方面均有显著疗效。然而临床胰岛移植目前仍面临供体资源紧缺、胰岛移植物早期定植、存活困难和排斥反应等亟待解决的难题。未来应在提高捐献胰腺数量及有效利用率的基础上,积极推进异种胰岛移植和干细胞来源胰岛移植的临床探索,有效解决胰岛来源不足的问题。同时通过不断研发新材料、新技术,优化胰岛移植部位,提高胰岛移植物定植与存活,并逐步摆脱对免疫抑制剂的依赖。此外,应积极推进胰岛移植后移植物监测手段的研发和应用,进一步保障胰岛移植后移植物的长期存活,让更多糖尿病患者从中受益。

Islet transplantation has developed rapidly over the last 20 years and is becoming one of the ideal clinical treatment options for type 1 diabetes mellitus(T1DM).There is growing clinical evidence that islet transplantation has significant efficacy in insulin independence or reduction,preventing hypoglycemic episodes and preventing diabetic complications.However,clinical islet transplantation still faces challenges,such as a shortage of donor resources,difficulties in early implantation and survival of islet grafts,and immune rejection.In the future,donor pancreatic donation and its effective utilization should be promoted,and clinical exploration of xenogeneic islet transplantation and stem cell-derived islet transplantation should be encouraged to effectively solve the problem of insufficient islet source.At the same time,through continuous research and development of new materials and technologies,optimize the location of islet transplantation to improve the implantation and survival of islet grafts,and gradually eliminate the need for immunosuppression.In addition,we should actively promote the development and application of post-islet transplantation graft monitoring tools to further ensure the long-term survival of post-islet transplantation grafts,so that more diabetic patients can benefit from it.