Impact of islet size on pancreatic islet transplantation and potential interventions to improve outcome.

Better results have been recently reported in clinical pancreatic islet transplantation (ITX) due mostly to improved isolation techniques and immunosuppression; however, some limitations still exist. It is known that following transplantation from 30 to 60% of the islets is lost. In our study, we have investigated: 1) the role of size as a factor affecting islet engraftment and, 2) potential procedural manipulations to increase the number of smaller functional islets that can be transplanted. C57/BL10 mice were used as donors and recipients in a syngeneic islet transplant model. Isolated islets were divided by size (large, >300 µm; medium 150–300 µm; small, ρ50 µm). Each size was transplanted in chemically induced diabetic mice as full (600 IEq), suboptimal (400 IEq), and marginal mass (200 IEq). Control animals received all size islets. Engraftment was defined as reversal of diabetes by day 7 post-transplantation. When the superiority of smaller islets was observed, strategies of over-digestion and fragmentation were adopted during islet isolation in the attempt to reduce islet size and improve engraftment. Smaller islets were significantly superior in engraftment as compared to medium, large, and control (all sizes) groups. This was more evident when marginal mass data were compared. In all masses, success decreased as islet sizes increased. Once islets were engrafted, functionality was not affected by size. When larger islets were fragmented, a significant decrease in islet functionality was observed. On the contrary, if pancreata were slightly over-digested, although not as successful as small naive islets, an increase in engraftment was observed when compared to the control group. In conclusion, smaller islets are superior in engraftment following islet transplantation. Fragmentation has a deleterious effect on islet engraftment. Islet isolations can be performed reducing islet size with slight over-digestion and it can be safely adopted to improve clinical outcome.