Rates of microbial infection observed in pancreatic Islet transplantation recipients concordant with microbial contamination of Islet transport and transplant solutions 1 2 2 Andre Liu , Vishaan Nursey , Benjamin Lalani, Renee Rilo , Manuel Beltran Del 2 1,2 2 Rio , Joel Stern , Horacio Rilo 1Donald
and Barbara Zucker School of Medicine at Hofstra/Northwell,
2Feinstein
Institute for Medical Research
Background
Results
Conclusions
Pancreatic islet transplantation is an experimental procedure that has been proven to consistently and effectively treat type 1 Diabetes.2 Islets can be harvested from a donor pancreas of another individual (allo-transplantation) or from a patient’s own organ 1 (auto-transplantation). Bacterial cultures are obtained and tested for microbial contamination at various stages during the Islet isolation process.5 The goal of this review was to determine the rates of contamination during Islet isolation for autotransplantation and to determine if microbial contamination during the isolation process led to concordant post-operative infectious complications.
The results indicate that while microbial contamination of the transport and/or final transplant solution is frequent, the rate of concordant infection observed in transplant recipients is very low.1,2,3,4,5 Auto-islet transport solution had a 53% contamination rate. Final auto-islet transplant solutions had a 35% contamination rate. Postoperative infectious complications were observed in 26% of patients receiving an auto islet transplant. Only 4% of all infectious complications observed in these recipients were concordant with the microbial contamination present in the transport and/or transplant solutions.
Bacterial positive transport solutions do not seem to impact rates of infectious complications from concordant organisms. Islet cultures tend to be culture positive in transport or transplant solutions, but appear to be infrequently related to the specific post-operative infectious complications. The majority of postoperative infections reviewed were due to organisms dissimilar from the contaminants of the respective transport or transplant solutions. More research is needed to draw definitive conclusions, however.
Hypothesis We hypothesized that rates of microbial contamination during islet isolation would correlate positively with concordant post-operative infectious complications.
Methods A literature review was conducted to collect microbial contamination data from multiple institutions performing auto-islet transplantations. Microbial contamination in transport solution and the final preparation of islet cells that are to be transplanted was recorded and analyzed. The causes of any infectious complications that arose postFigure 1: Summary of auto-islet solution contamination and infection operatively were compared with microbial contamination Figure 7: Independent CRISPR knockout of CDK4 or CDK6 does not cause dropout in most breast cancer cell lines rates data from both transport and transplant solutions in order studied. to determine if the post-operative infection was concordant with any microorganisms found in the solutions.
Future Direction Several areas of future research were identified during this study. Data on infectious complications of allotransplant studies was sparse compared with the data on auto-transplants. Further research into infectious complications in allo-transplants would make an interesting comparison to the information on autotransplants presented here. Additionally, many of the studies we summarized did not describe the treatments used in the case of infectious complications, which would also be useful to have more data on.
Resources 1. Berger MG, Majumder K, Hodges JS, Bellin MD, Schwarzenberg SJ, Gupta S, Dunn TB, Beilman GJ, Pruett TL, Freeman ML, Wilhelm JJ, Sutherland DE, Chinnakotla S. Microbial contamination of transplant solutions during pancreatic islet autotransplants is not associated with clinical infection in a pediatric population. Pancreatology. 2016 Jul-Aug;16(4):555-62. doi: 10.1016/j.pan.2016.03.019. Epub 2016 Apr 6. PMID: 27134135. 2. Colling KP, Blondet JJ, Balamurugan AN, Wilhelm JJ, Dunn T, Pruett TL, Sutherland DE, Chinnakotla S, Bellin M, Beilman GJ. Positive sterility cultures of transplant solutions during pancreatic islet autotransplantation are associated infrequently with clinical infection. Surg Infect (Larchmt). 2015 Apr;16(2):115-23. doi: 10.1089/sur.2013.224. Epub 2015 Feb 10. PMID: 25668050. 3. Gołębiewska JE, Bachul PJ, Fillman N, Kijek MR, Basto L, Para M, Perea L, Gołąb K, Wang LJ, Tibudan M, Dębska-Ślizień A, Matthews JB, Fung J, Witkowski P. Early Infectious Complications After Total Pancreatectomy with Islet Autotransplantation: a Single Center Experience. J Gastrointest Surg. 2019 Nov;23(11):2201-2210. doi: 10.1007/s11605-019-04118-y. Epub 2019 Feb 4. PMID: 30719679. 4. Lakey JR, Rajotte RV, Warnock GL. Microbial surveillance of human islet isolation, in vitro culture, and cryopreservation. Clin Invest Med. 1995 Jun;18(3):168-76. PMID: 7554583. 5. Wray, C. J., Ahmad, S. A., Lowy, A. M., D’Alessio, D. A., Gelrud, A., Choe, K. A., . . . Rodriguez-Rilo, H. L. (2005). Clinical significance of bacterial cultures from 28 autologous islet cell transplant solutions. Pancreatology, 5(6), 562-569. doi:10.1159/000087498