Strategies Attention to detail, every step
Optimal donor selection:
- Excluding pancreases from donors = age 50
- Ischemic protection - PFC/UW for ɠ hrs storage
Avoiding islet-toxic reagents during processing (Iodixanol gradients)
Islet culture to facilitate inductive conditioning of recipient
Potent prophylactic anticoagulation (70 u/kg heparin, then 300 u/hr)
Aggressive peritransplant insulin therapy for antiinflammatory + islet �rest�
Anti-inflammatory treatment (Etanercept)
Potent anti-T cell induction (hOKT3-ala-ala / thymoglobulin)
Calcineurin inhibitor avoidance in maintenance immunosuppression
Careful recipient selection:
- Insulin requirements 0.55 U/kg/day (range 0.37 - 0.76)
- Recipient weight 59.6kg (range 42 - 66kg)