HUMAN PANCREATIC ISLET TRANSPLANTATION IN INTERNATIONAL COLLABORATION WITH A DISTANT ISLET ISOLATION CENTER: PRELIMINARY RESULTS FROM THE BUDAPEST-GENEVA EXPERIENCE

P448 Aims: Although, recent developments in clinical islet transplantation led to insulin independence in several patients with type 1 diabetes mellitus, isolation of a large number of high-quality human islets for transplantation still remains a great challenge. To overcome the critical islet processing and to ensure patient safety and quality care, we have established an international collaboration between two geographically distant transplant centers. Methods: All pancreata were harvested from multiorgan cadaveric donors in Hungary and were procured by the same team. Careful attention was paid to pancreas harvesting, using no-touch technique and rapid preparation. The pancreata were immediately preserved by the two-layer method (oxigenated perfluorocarbon+UW) and subsequently transported by scheduled regular flight for isolation to Cell Isolation and Transplantation Center, Geneva University Hospitals which is situated at a distance of 1400 km from Budapest. Islets were isolated after enzymatic ductal perfusion of the pancreas using the automated method. After purification, the islets were cultured overnight, then transported back to Budapest also with a scheduled flight. Upon arrival the islets were assessed for viability. Two consecutive kidney transplant patients with type 1 diabetes mellitus, from our IAK waiting list, underwent islet transplantation via percutaneous transhepatic portal embolization using the “bag-method”. The immunosuppression followed the Edmonton-protocol and consisted of daclizumab, sirolimus and low-dose tacrolimus. Results: Median donor age was 44 years (35-54), mean BMI: 25.6. The average time from donor aortic cross-clamp to pancreas procurement was 23 minutes. The islet isolation process began within 8 hours from the donor aorta cross-clamp in all cases. The isolation success rate was 75% (3/4). After overnight culture, the islets were transported back to Budapest and assessed for viability which was >80% in all cases. No complications have occurred during the transplantation, the portal pressure remained within the normal range. The first patient has received 12 000IE/BW from two donors and insulin requirement decreased from 40U/day to 10U/day. The second patient has received 7200IE/BW from single donor and became immediately insulin free. Posttransplantation follow-up for these two patients are 3 and 1 months, respectively. Both patients achieved metabolic stability, the mean glycosylated hemoglobin values have been reduced, none of them have had a hyper- or hypoglycemic episode since islet transplantation. Conclusions: The experience of a traditional islet transplant center, possessing the advanced pancreatic islet isolation techniques, combined with strict donor and recipient selection criteria, suitable organ harvesting and recipient management could overcome national borders and could result in an excellent international collaboration. These preliminary results demonstrate the feasibility of an international collaborative islet transplantation program at a distance over 1000 km.

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