Failed femorocrural reconstruction does not prejudice amputation level

✍ Scribed by J. D. Beard; G. M. K. Tsang; M. C. Crowson; N. C. Hickey; M. H. Simms

• Book ID: 101748202
• Publisher: John Wiley and Sons
• Year: 1992
• Tongue: English
• Weight: 266 KB
• Volume: 79
• Category: Article
• ISSN: 0007-1323
• DOI: 10.1002/bjs.1800790756

✦ Synopsis

numbers of viable, sterile islets from a single human pancreas and it would seem that the major problem facing islet transplantation at the moment is not transplanting sufficient islets, but preventing those islets that have been transplanted from being rejected.

4. The article made clear that at the present time islet transplantation is not routinely successful.

5. There is no evidence whatsoever that human islets are more immunogenic than vascularized pancreas grafts, although on the basis of the available data it would be reasonable to conclude that they are equally immunogenic. The paper that Mr Koo Seen Lin quotes was an experimental study in rats. We agree with him that the concept of immunomodulation being concerned purely with the functional deletion of antigen-presenting cells is outdated; indeed we have recently shown' that tissue-cultured human islets and exocrine tissue express major histocompatibility complex (MHC) class I and I1 antigens.

Mr Koo Seen Lin's work on cultured human fetal pancreas tissue is fascinating, but he should be careful not to extrapolate results with fetal pancreas tissue cultured in the presence of interferon-? to the situation with human islets cultured in the absence of such substances that are known to enhance MHC expression.

We agree with Mr Koo Seen Lin that investigators involved in islet transplantation are aware of the challenges that lie ahead. If advances in the field continue at their present rate, then providing that these hurdles are approached in a scientific and rational manner, there is every reason to think that the finishing tape is in sight.