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Advisor(s)
Abstract(s)
Enquadramento: A Diabetes tipo 1 é uma doença imunomediada que tem
sofrido um aumento da sua incidência. O seu actual tratamento, apesar dos grandes
avanços, tem eficácia incompleta, pois é incómodo e está associado, entre outros, a
hipoglicemias e não evita por completo as complicações tardias. Nesse sentido, novas
alternativas têm sido estudas e a reposição dos ilhéus de Langerhans, por transplante
total, ou de ilhéus, é uma modalidade terapêutica que tem sofrido grandes alterações.
Objectivo: Analisar estudos de transplante de ilhéus e verificar a sua eficácia e
aplicabilidade no tratamento da Diabetes tipo 1.
Materiais e Métodos: Realizou-se pesquisa para identificar artigos na base de
dados MEDLINE. Foram utilizadas as palavras-chave [type 1 diabetes], [pancreatic
transplantation], [pancreatic islet transplantation]. Realizou-se também pesquisa
partindo de referências de artigos e utilizaram-se limites relativamente à língua e
autores.
Resultados: Dezanove estudos, que realizaram transplante de ilhéus isolado,
simultaneamente ou após rim, partindo de dadores humanos, em diabéticos tipo 1,
foram seleccionados. A maioria dos estudos mais recentes alcançou 100% de
independência de insulina ou próximo, durante um período temporário após o
transplante. Aqueles com seguimento mais longo mostraram que apenas 7,5% dos
pacientes o permaneciam após cinco anos. A função parcial do enxerto teve melhores
resultados, estando presente em 80% dos pacientes após cinco anos, com melhoria do
controlo metabólico. A melhoria dos resultados deveu-se aos desenvolvimentos que têm
ocorrido. Os maiores verificaram-se com a introdução do Protocolo de Edmonton, em
2000, preconizando, entre outros, imunossupressão sem corticosteroides. Posteriormente, surgiu o Protocolo de Quioto para melhorar a utilização de
dadores cadáveres. Estes investigadores utilizaram pela primeira vez um dador vivo.
Desenvolvimentos também ocorreram nas técnicas de preparação dos ilhéus. Contudo,
complicações relacionadas com o procedimento e imunossupressão ainda são
frequentes, assim como a escassez de dadores, tornando essencial equilibrar a razão
risco-benefício na selecção dos candidatos para transplante.
Conclusões: O transplante de ilhéus pancreáticos tem sofrido grandes alterações
e o que parecia não ter sucesso, comparando com o transplante total, tem-se tornado na
melhor opção para “curar” a Diabetes tipo 1. Apesar dos resultados apresentados
parecerem demonstrar que esta estratégia pode ser eficaz, estes são menos favoráveis a
longo prazo. A falta de dadores e a imunossupressão são os seus principais entraves,
pelo que tem surgido interesse em técnicas alternativas.
Background: Type 1 Diabetes is an immunomediated disease which has been suffering an increase in its incidence. Despite the great advances, its current treatment has incomplete efficacy, because it is uncomfortable and it is associated, for example, to hypoglycaemia and does not avoid completely the late complications. In this way, new alternatives have been studied and replacement of islets of Langerhans, by total pancreatic transplantation, or islet transplantation, is a therapeutic modality that has undergone major changes. Purpose: To analyse some islet transplant studies and verify its efficacy and applicability in the treatment of Type 1 Diabetes. Material and Methods: A research was performed to identify articles in database MEDLINE. The following keywords were used: [type 1 diabetes]; [pancreatic transplantation]; [pancreatic islet transplantation]. Another research using reference lists from articles and with language and authors limits was performed. Results: Nineteen studies, which underwent isolated, islet-kidney or after kidney transplantation, from human donors, in type 1 diabetic patients, were selected. Most of the more recent studies reached 100% of independence of insulin or near, for a temporary period of time after the transplant. Those with longer follow up showed that only 7.5% of the patients remained independent after five years. The partial graft function had better results and it is present in 80% of the patients after five years, with improved metabolic control. The improvement in results was due to developments that have been occurring. The great advances occurred with the introduction of the Edmonton Protocol in 2000, using a glucocorticoid-free immunosuppression. Recently, Kyoto Protocol appeared to improve the use of cadaveric donors. These researchers experiment for the first time a living-donor islet transplant. Developments also occurred in the islet preparation techniques. However, complications related to the procedure and immunosuppression are still frequent, and the shortage of donors, making the riskbenefit ratio balance essential in the selection of transplant candidates. Conclusions: Great improvements have occurred in the islet transplantation and what seemed to not succeed, compared with the total transplantation, has become the best option to “cure” Type 1 Diabetes. Despite the findings seem to demonstrate that this strategy can be effective, long term outcomes are not so good. The lack of donors and immunosuppression are the main obstacles, and it has arisen interest in alternative techniques.
Background: Type 1 Diabetes is an immunomediated disease which has been suffering an increase in its incidence. Despite the great advances, its current treatment has incomplete efficacy, because it is uncomfortable and it is associated, for example, to hypoglycaemia and does not avoid completely the late complications. In this way, new alternatives have been studied and replacement of islets of Langerhans, by total pancreatic transplantation, or islet transplantation, is a therapeutic modality that has undergone major changes. Purpose: To analyse some islet transplant studies and verify its efficacy and applicability in the treatment of Type 1 Diabetes. Material and Methods: A research was performed to identify articles in database MEDLINE. The following keywords were used: [type 1 diabetes]; [pancreatic transplantation]; [pancreatic islet transplantation]. Another research using reference lists from articles and with language and authors limits was performed. Results: Nineteen studies, which underwent isolated, islet-kidney or after kidney transplantation, from human donors, in type 1 diabetic patients, were selected. Most of the more recent studies reached 100% of independence of insulin or near, for a temporary period of time after the transplant. Those with longer follow up showed that only 7.5% of the patients remained independent after five years. The partial graft function had better results and it is present in 80% of the patients after five years, with improved metabolic control. The improvement in results was due to developments that have been occurring. The great advances occurred with the introduction of the Edmonton Protocol in 2000, using a glucocorticoid-free immunosuppression. Recently, Kyoto Protocol appeared to improve the use of cadaveric donors. These researchers experiment for the first time a living-donor islet transplant. Developments also occurred in the islet preparation techniques. However, complications related to the procedure and immunosuppression are still frequent, and the shortage of donors, making the riskbenefit ratio balance essential in the selection of transplant candidates. Conclusions: Great improvements have occurred in the islet transplantation and what seemed to not succeed, compared with the total transplantation, has become the best option to “cure” Type 1 Diabetes. Despite the findings seem to demonstrate that this strategy can be effective, long term outcomes are not so good. The lack of donors and immunosuppression are the main obstacles, and it has arisen interest in alternative techniques.
Description
Keywords
Transplante de pâncreas - Diabetes Mellitus tipo 1 Diabetes Mellitus tipo 1 - Insulina Transplantes de Ilhéus Pancreáticos Transplantes de Ilhéus Pancreáticos - Rejeição
Pedagogical Context
Citation
Publisher
Universidade da Beira Interior