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Triolo TM, Bellin MD. Lessons from Human Islet Transplantation Inform Stem Cell-Based Approaches in the Treatment of Diabetes. Front Endocrinol (Lausanne) 2021; 12:636824. [PMID: 33776933 PMCID: PMC7992005 DOI: 10.3389/fendo.2021.636824] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/01/2021] [Indexed: 12/15/2022] Open
Abstract
Diabetes mellitus is characterized by the body's inability to control blood glucose levels within a physiological range due to loss and/or dysfunction of insulin producing beta cells. Progressive beta cell loss leads to hyperglycemia and if untreated can lead to severe complications and/or death. Treatments at this time are limited to pharmacologic therapies, including exogenous insulin or oral/injectable agents that improve insulin sensitivity or augment endogenous insulin secretion. Cell transplantation can restore physiologic endogenous insulin production and minimize hyper- and hypoglycemic excursions. Islet isolation procedures and management of transplant recipients have advanced over the last several decades; both tight glycemic control and insulin independence are achievable. Research has been conducted in isolating islets, monitoring islet function, and mitigating the immune response. However, this procedure is still only performed in a small minority of patients. One major barrier is the scarcity of human pancreatic islet donors, variation in donor pancreas quality, and variability in islet isolation success. Advances have been made in generation of glucose responsive human stem cell derived beta cells (sBCs) and islets from human pluripotent stem cells using directed differentiation. This is an emerging promising treatment for patients with diabetes because they could potentially serve as an unlimited source of functional, glucose-responsive beta cells. Challenges exist in their generation including long term survival of grafts, safety of transplantation, and protection from the immune response. This review focuses on the progress made in islet allo- and auto transplantation and how these advances may be extrapolated to the sBC context.
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Affiliation(s)
- Taylor M. Triolo
- The Barbara Davis Center for Diabetes, School of Medicine, University of Colorado Denver, Aurora, CO, United States
- *Correspondence: Taylor M. Triolo,
| | - Melena D. Bellin
- Department of Pediatrics, School of Medicine, University of Minnesota, Minneapolis, MN, United States
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Patiño-Diaz K, Mexicano E, Vergara N, Contreras C, Sanchez-Valdivieso E. Occlusion of the Main Pancreatic Duct as a Method to Avoid a Pancreatojejunal Anastomosis: Metabolic Consequences. DUBAI MEDICAL JOURNAL 2019. [DOI: 10.1159/000503383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Introduction:</i></b> The poor prognosis seen after the Whipple procedure greatly depends on leaks from pancreatic-duodenal anastomosis. <b><i>Objective:</i></b> To evaluate ligation of the pancreatic duct without reconstruction of the gastrointestinal tract continuity to prevent pancreatic postoperative fistula occurrence and to reduce surgical time. <b><i>Methods:</i></b> An experimental study was carried out on New Zealand adult rabbits who underwent pancreatic duct ligation without pancreatic-duodenal anastomosis. Pancreatic enzyme was administered orally to one operated group; another group of animals was operated on and monitored without enzyme replacement. <b><i>Results:</i></b> The groups were compared, and variations in weight and metabolic profiles were assessed. No significant differences were found between both operated groups in terms of postoperative mortality or reoperations. <b><i>Discussion/Conclusion:</i></b> The morbidity associated with pancreatic duct ligation is low, the procedure is well tolerated, and endocrine insufficiency does not seem to be a problem in the animal model.
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Bellin MD, Beilman GJ, Sutherland DER, Ali H, Petersen A, Mongin S, Kirchner V, Schwarzenberg SJ, Trikudanathan G, Freeman ML, Pruett TL, Chinnakotla S. How Durable Is Total Pancreatectomy and Intraportal Islet Cell Transplantation for Treatment of Chronic Pancreatitis? J Am Coll Surg 2019; 228:329-339. [DOI: 10.1016/j.jamcollsurg.2018.12.019] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022]
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Pediatric chronic pancreatitis: Updates in the 21st century. Pancreatology 2018; 18:354-359. [PMID: 29724605 DOI: 10.1016/j.pan.2018.04.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 04/25/2018] [Accepted: 04/26/2018] [Indexed: 12/11/2022]
Abstract
Pediatric Pancreatitis has gained a lot of attention in the last decade. Updates in medical management include new testing technologies in genetics, function testing and imaging modalities. Updates in surgical management have taken place as well, with total pancreatectomy islet auto transplantation reserved for a specific patient population that meets the clinical criteria. Multidisciplinary team management is needed for patients with chronic pancreatitis to ensure optimal outcomes.
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Webb MA, Chen JJ, James RFL, Davies MJ, Dennison AR. Elevated Levels of Alpha Cells Emanating from the Pancreatic Ducts of a Patient with a Low BMI and Chronic Pancreatitis. Cell Transplant 2018; 27:902-906. [PMID: 29852747 PMCID: PMC6050909 DOI: 10.1177/0963689718755707] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Chronic pancreatitis (CP) is an inflammatory disease that causes progressive damage to
the pancreatic parenchyma with irreversible morphological changes and fibrotic replacement
of the gland. The risk factors associated with developing CP have been described as toxic
(e.g., alcohol and tobacco); idiopathic (e.g., unknown); genetic, autoimmune, recurrent
acute pancreatitis, and obstructive (the TIGAR-O system). Upon histological screening of
the pancreata from a cohort of CP patients who had undergone pancreatectomy for the
treatment of intractable pain in Leicester, UK, one sample showed a striking change in the
morphological balance toward an endocrine phenotype, most notably there was evidence of
substantial α cell genesis enveloping entire cross sections of ductal epithelium and the
presence of α cells within the ductal lumens. This patient had previously undergone a
partial pancreatectomy, had severe sclerosing CP, an exceptionally low body mass index
(15.2), and diabetes at the time the pancreas was removed, and although these factors have
been shown to induce tissue remodeling, such high levels of α cells was an unusual finding
within our series of patients. Due to the fact that α cells have been shown to be the
first endocrine cell type that emerges during islet neogenesis, future research profiling
the factors that caused such marked α cell genesis may prove useful in the field of islet
transplantation.
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Affiliation(s)
- M'Balu A Webb
- 1 The Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Jane J Chen
- 2 Department of Hepatobiliary Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Roger F L James
- 3 Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, United Kingdom
| | - Melanie J Davies
- 1 The Leicester Diabetes Centre, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,4 Diabetes Research Centre, University of Leicester, Leicester, United Kingdom
| | - Ashley R Dennison
- 2 Department of Hepatobiliary Surgery, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
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Yin N, Chen T, Yu Y, Han Y, Yan F, Zheng Z, Chen Z. Facile mechanical shaking method is an improved isolation approach for islet preparation and transplantation. Exp Ther Med 2016; 12:3658-3664. [PMID: 28101160 PMCID: PMC5228319 DOI: 10.3892/etm.2016.3844] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 09/15/2016] [Indexed: 12/13/2022] Open
Abstract
Successful islet isolation is crucial for islet transplantation and cell treatment for type 1 diabetes. Current isolation methods are able to obtain 500-1,000 islets per rat, which results in a waste of ≥50% of total islets. In the present study, a facile mechanical shaking method for improving islet yield (up to 1,500 per rat) was developed and summarized, which was demonstrated to be more effective than the existing well-established stationary method. The present results showed that isolated islets have a maximum yield of 1,326±152 when shaking for 15 min for the fully-cannulated pancreas. For both fully-cannulated and half-cannulated pancreas in the presence of rat DNAse inhibitor, the optimal shaking time was amended to 20 min with a further increased yield of 1,344±134 and 1,286±124 islets, respectively. Furthermore, the majority of the isolated islets were morphologically intact with a well-defined surface and almost no central necrotic zone, which suggested that the condition of islets obtained via the mechanical shaking method was consistent with the stationary method. Islet size distribution was also calculated and it was demonstrated that islets from the stationary method exhibited the same size distribution as the non-cannulated group, which had more larger islets than the fully-cannulated and half-cannulated groups isolated via the shaking method. In addition, the results of glucose challenge showed that the refraction index of each group was >2.5, which indicated the well-preserved function of isolated islets. Furthermore, the transplanted islets exhibited a therapeutic effect after 1 day of transplantation; however, they failed to control blood glucose levels after ~7 days of transplantation. In conclusion, these results demonstrated that the facile mechanical shaking method may markedly improve the yield of rat islet isolation, and in vitro and in vivo investigation demonstrated the well-preserved function of isolated islets in the control of blood glucose. Therefore, the facile mechanical shaking method may be an alternative improved procedure to obtain higher islet yield for islet preparation and transplantation in the treatment of type 1 diabetes.
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Affiliation(s)
- Nina Yin
- Department of Anatomy, College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Tao Chen
- Department of Anatomy, College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Yuling Yu
- Department of Anatomy, College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Yongming Han
- Department of Anatomy, College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Fei Yan
- Department of Anatomy, College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Zhou Zheng
- Department of Anatomy, College of Basic Medicine, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
| | - Zebin Chen
- Department of Acupuncture and Moxibustion, College of Acupuncture and Orthopedics, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China; Hubei Provincial Collaborative Innovation Center of Preventive Treatment by Acupuncture and Moxibustion, Hubei University of Chinese Medicine, Wuhan, Hubei 430065, P.R. China
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Abstract
PURPOSE OF REVIEW This article provides a summary of the current outcomes of β-cell replacement strategies, an algorithm for choosing a specific modality while highlighting associated advantages and disadvantages, and outlines remaining challenges and areas of active investigation in β-cell replacement therapy. RECENT FINDINGS The most recent reports of islet cell allotransplantation have shown improvements over previous eras and now rival some outcomes of pancreas alone transplantation. Active areas of investigation are focused on improving techniques for islet isolation, graft monitoring, and managing challenges posed by the innate and alloimmune systems. SUMMARY Patients with insulin-dependent diabetes who continue to experience life threatening hypoglycemia despite maximal medical management can benefit from β-cell replacement. Emerging nontransplant technologies have not provided a physiologic euglycemic state to the extent offered by transplantation. Islet transplantation eliminates hypoglycemic episodes/unawareness, facilitates normalization of hemoglobin A1c (HbA1c), decreases microvascular disease progression, and improves quality of life for patients with problematic diabetes. Mid- and long-term outcomes of islet transplantation performed at expert centers approximate those of registry reports of solitary pancreas transplant, whereas the complication profile is quite favorable.
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Abstract
We found that the secreted protein periostin (Postn) is highly induced after partial pancreatectomy in regenerating areas containing mesenchymal stroma and tubular complexes. Importantly, after partial pancreatectomy, Postn-deficient mice exhibit impaired mesenchymal formation and reduced regeneration specifically within the pancreatic β-cell compartment. Furthermore, Postn-deficient mice demonstrate an increased sensitivity to streptozotocin. Notably, injection of Postn directly into the pancreas stimulated proliferation of vimentin-expressing cells within 24 hours, and by 3 days, a mesenchymal stroma was present containing proliferating duct-like cells expressing the progenitor markers Ngn3 and Pdx1. Intraperitoneal injection of Postn resulted in increased numbers of islets and long-term glucoregulatory benefits with no adverse effects found in other tissues. Delivery of Postn throughout the pancreas via the common bile duct resulted in increased numbers of small insulin-expressing clusters and a significant improvement in glucose tolerance. Therefore, Postn is novel molecule capable of potentiating pancreatic β-cell regeneration.
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Affiliation(s)
- Johnathan K Smid
- Sprott Center for Stem Cell Research (J.K.S., S.F., M.A.R.), Ottawa Hospital Research Institute, Regenerative Medicine Program, and University of Ottawa (J.K.S., M.A.R.), Cellular and Molecular Medicine, Faculty of Medicine, Ottawa, Ontario, Canada K1H 8L6
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Qi M, Kinzer K, Danielson KK, Martellotto J, Barbaro B, Wang Y, Bui JT, Gaba RC, Knuttinen G, Garcia-Roca R, Tzvetanov I, Heitman A, Davis M, McGarrigle JJ, Benedetti E, Oberholzer J. Five-year follow-up of patients with type 1 diabetes transplanted with allogeneic islets: the UIC experience. Acta Diabetol 2014; 51:833-43. [PMID: 25034311 PMCID: PMC4801517 DOI: 10.1007/s00592-014-0627-6] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 07/01/2014] [Indexed: 12/16/2022]
Abstract
This report summarizes a 5-year phase 1/2 allogeneic islet transplantation clinical trial conducted at the University of Illinois at Chicago (UIC). Ten patients were enrolled in this single center, open label, and prospective trial in which patients received 1-3 transplants. The first four subjects underwent islet transplantation with the Edmonton immunosuppressive regimen and the remaining six subjects received the UIC immunosuppressive protocol (Edmonton plus etanercept and exenatide). All 10 patients achieved insulin independence after 1-3 transplants. At 5 years of follow-up, 6 of the initial 10 patients were free of exogenous insulin. During the follow-up period, 7 of the 10 patients maintained positive C-peptide levels and a composite hypoglycemic score of 0. Most patients maintained HbA1c levels <6.0 % (42.1 mmol/mol) and a significantly improved β-score. In conclusion, this study demonstrated long-term islet graft function without using T cell depleting induction, with an encouraging outcome that includes 60 % of patients remaining insulin independent after 5 years of initial transplantation.
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Affiliation(s)
- Meirigeng Qi
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Katie Kinzer
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Kirstie K. Danielson
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Joan Martellotto
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Barbara Barbaro
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Yong Wang
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - James T. Bui
- Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612
| | - Ron C. Gaba
- Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612
| | - Grace Knuttinen
- Department of Radiology, University of Illinois at Chicago, Chicago, IL 60612
| | - Raquel Garcia-Roca
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Ivo Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | | | - Maureen Davis
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - James J. McGarrigle
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
| | - Jose Oberholzer
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612
- Corresponding Author: José Oberholzer, MD, MHCM, FACS, University of Illinois at Chicago, 840 South Wood Street CSB (Rm 402), Chicago, Illinois 60612, USA, Tel: +1 312 996 6771, Fax: +1 312 413 3483,
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Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes. Ann Surg 2014; 260:56-64. [PMID: 24509206 DOI: 10.1097/sla.0000000000000569] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Describe the surgical technique, complications, and long-term outcomes of total pancreatectomy and islet autotransplantation (TP-IAT) in a large series of pediatric patients. BACKGROUND Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long-term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, whereas islet autotransplantation (IAT) potentially can prevent or minimize TP-related diabetes. METHODS Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic, or surgical treatment between 1989 and 2012. RESULTS Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P < 0.001). The relief from narcotics was sustained. Of the 75 patients undergoing TP-IAT, 31 (41.3%) achieved insulin independence. Younger age (P = 0.032), lack of prior Puestow procedure (P = 0.018), lower body surface area (P = 0.048), higher islet equivalents (IEQ) per kilogram body weight (P = 0.001), and total IEQ (100,000) (P = 0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT: (1) male sex, (2) lower body surface area, and (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (odds ratio = 2.62; P < 0.001). CONCLUSIONS Total pancreatectomy and islet autotransplantation provides sustained pain relief and improved quality of life. The β-cell function is dependent on islet yield. Total pancreatectomy and islet autotransplantation is an effective therapy for children with painful pancreatitis that failed medical and/or endoscopic management.
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Abstract
The goal of IAT is the preservation of beta-cell mass at the time of pancreatectomy. The majority of recipients have significant endogenous beta-cell function with positive blood C-peptide after surgery, even if only approximately one third achieve insulin independence. In appropriately selected patients, total pancreatectomy combined with IAT achieves relief of pain and improves quality of life with relatively easier-to-manage glycemic control and avoidance of hyper- and hypoglycemic episodes. Current research is focused on improving techniques of islet isolation and engraftment as well as long-term survival of autografted islets.
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Butler AE, Campbell-Thompson M, Gurlo T, Dawson DW, Atkinson M, Butler PC. Marked expansion of exocrine and endocrine pancreas with incretin therapy in humans with increased exocrine pancreas dysplasia and the potential for glucagon-producing neuroendocrine tumors. Diabetes 2013; 62:2595-604. [PMID: 23524641 PMCID: PMC3712065 DOI: 10.2337/db12-1686] [Citation(s) in RCA: 326] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Controversy exists regarding the potential regenerative influences of incretin therapy on pancreatic β-cells versus possible adverse pancreatic proliferative effects. Examination of pancreata from age-matched organ donors with type 2 diabetes mellitus (DM) treated by incretin therapy (n = 8) or other therapy (n = 12) and nondiabetic control subjects (n = 14) reveals an ∼40% increased pancreatic mass in DM treated with incretin therapy, with both increased exocrine cell proliferation (P < 0.0001) and dysplasia (increased pancreatic intraepithelial neoplasia, P < 0.01). Pancreata in DM treated with incretin therapy were notable for α-cell hyperplasia and glucagon-expressing microadenomas (3 of 8) and a neuroendocrine tumor. β-Cell mass was reduced by ∼60% in those with DM, yet a sixfold increase was observed in incretin-treated subjects, although DM persisted. Endocrine cells costaining for insulin and glucagon were increased in DM compared with non-DM control subjects (P < 0.05) and markedly further increased by incretin therapy (P < 0.05). In conclusion, incretin therapy in humans resulted in a marked expansion of the exocrine and endocrine pancreatic compartments, the former being accompanied by increased proliferation and dysplasia and the latter by α-cell hyperplasia with the potential for evolution into neuroendocrine tumors.
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Affiliation(s)
- Alexandra E Butler
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA.
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Pancreatic islet autotransplantation with total pancreatectomy for chronic pancreatitis. Surg Today 2012; 43:715-9. [DOI: 10.1007/s00595-012-0382-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 07/26/2012] [Indexed: 12/11/2022]
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Bellin M, Balamurugan A, Pruett TL, Sutherland DE. No islets left behind: islet autotransplantation for surgery-induced diabetes. Curr Diab Rep 2012; 12:580-6. [PMID: 22777430 PMCID: PMC3432727 DOI: 10.1007/s11892-012-0296-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
For patients with severe chronic pancreatitis refractory to medical interventions, total pancreatectomy can be considered to relieve the root cause of pain. The goal of a simultaneous islet autotransplant is to prevent or minimize the otherwise inevitable surgical diabetes. Islet autotransplant can successfully preserve some endogenous islet function in the majority of recipients, which mediates protection against brittle diabetes. Most maintain reasonably good glycemic control, while 30 %-40 % successfully discontinue insulin therapy. With islet autotransplants reaching a wider clinical audience, refinements in islet isolation techniques and strategies to protect islet grafts post-transplant may further improve the success of this procedure.
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Affiliation(s)
- Melena Bellin
- University of Minnesota Amplatz Children’s Hospital, East Building, Rm MB-671, 2450 Riverside Ave E, Minneapolis, MN 55454
| | - A.N. Balamurugan
- University of Minnesota, Schulze Diabetes Institute, Department of Surgery, 420 Delaware St SE, Minneapolis, MN 55455, Phone 651-253-0656, Fax 612-626-5855,
| | - Timothy L. Pruett
- University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN 55455, 612-626-7282 Phone, 612-624-7168 Fax,
| | - David E.R. Sutherland
- University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN 55455, 612-625-7600 Phone, 612-624-7168 Fax,
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