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Production of tissue factor by pancreatic islet cells as a trigger of detrimental thrombotic reactions in clinical islet transplantation
Abstract
Background Intraportal transplantation of pancreatic islets offers improved glycaemic control and insulin independence in type 1 diabetes mellitus, but intraportal thrombosis remains a possible complication. The thrombotic reaction may explain why graft loss occurs and islets from more than one donor are needed, since contact between human islets and ABO-compatible blood in vitro triggers a thrombotic reaction that damages the islets. We investigated the possible mechanism and treatment of such thrombotic reactions. Methods Coagulation activation and islet damage were monitored in four patients undergoing clinical islet transplantation according to a modified Edmonton protocol. Expression of tissue factor (TF) in the islet preparations was investigated by immunohistochemistry, immunoprecipitation, electron microscopy, and RT-PCR. To assess TF activity in purified islets, human islets were mixed with non-anticoagulated ABO-compatible blood in tubing loops coated with heparin. Findings Coagulation activation and subsequent release of insulin were found consistently after clinical islet transplantation, even in the absence of signs of intraportal thrombosis. The endocrine, but not the exocrine, cells of the pancreas were found to synthesise and secrete active TF. The clotting reaction triggered by pancreatic islets in vitro could be abrogated by blocking the active site of TF with specific antibodies or site-inactivated factor VIIa, a candidate drug for inhibition of TF activity…
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“One consequence of this direct blood contact is an immune response called the instant blood-mediated inflammatory reaction (IBMIR).”
From Developments in stem cell-derived islet replacement therapy for treating type 1 diabetes (2023) · cites this paper as [139]
In the citing paper
“It is thought that a major cause of the initial islet death observed in the immediate aftermath of portal vein islet infusion is due to IBMIR.”
From Developments in stem cell-derived islet replacement therapy for treating type 1 diabetes (2023) · cites this paper as [139]
In the citing paper
“Within 15 minutes of contact with host blood, islets are encapsulated within a layer of platelets, reducing nutrient diffusion.”
From Developments in stem cell-derived islet replacement therapy for treating type 1 diabetes (2023) · cites this paper as [139]
In the citing paper
“Furthermore, leukocytes infiltrate the islets within an hour, leading to cell death.”
From Developments in stem cell-derived islet replacement therapy for treating type 1 diabetes (2023) · cites this paper as [139]
In the citing paper
“Because conventional islet transplantation by infusion into the hepatic portal vein suffers from certain limitations, such as acute graft loss triggered by an instant blood-mediated inflammatory response (IBMIR)”
From Transplantation of chemically induced pluripotent stem-cell-derived islets under abdominal anterior rectus sheath in a type 1 diabetes patient. (2024) · cites this paper as [24]
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“Amongst those, the tissue factor appears to be the most relevant one to trigger IBMIR as immediate innate immune response.(73)”
BackgroundYang, S.-Y., Yang, K.-C., & Sumi, S. (2020) · Transplantation Direct · doi:10.1097/txd.0000000000001078 · Cited by 6
Zammit, N., & Grey, S. (2017) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000000482 · Cited by 6
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“Non-specific inflammatory response is the main cause of primary non-function of islet transplantation.(34) Hence, research on artificial islet tissue derived from non-antigenic autologous stem cells will have a profound effect on the treatment of diabetes.”
BackgroundA hybrid of cells and pancreatic islets toward a new bioartificial pancreas
Teramura, Y., Ekdahl, K., & Barbu, A. (2016) · Regenerative Therapy · doi:10.1016/j.reth.2016.03.004 · Cited by 6
Self-citationNovel technologies to engineer graft for tolerance induction
Woodward, K. B., Wang, F., Zhao, H., Yolcu, E., & Shirwan, H. (2016) · Current Opinion in Organ Transplantation · doi:10.1097/mot.0000000000000270 · Cited by 6
“In fact, coagulation is fostered by the grafted islets through tissue factors expressed in response to stimuli associated with donor death, islet isolation and local injury to endothelial cells of islet microvasculature [4].”
BackgroundCoppens, V., Heremans, Y., Leuckx, G., Suenens, K., Jacobs-Tulleneers-Thevissen, D., Verdonck, K., Luttun, A., Heimberg, H., & Leu, N. D. (2013) · Islets · doi:10.4161/isl.26778 · Cited by 6
Lee, D.-Y. (2011) · Macromolecular Research · doi:10.1007/s13233-011-0904-y · Cited by 6
Transplante de ilhotas na prática clínica: estado atual e perspectivas
Eliaschewitz, F. G., Franco, D. R., dos Mares-Guia, T. R., Noronha, I. L., Labriola, L., & Sogayar, M. C. (2009) · Arquivos Brasileiros de Endocrinologia & Metabologia · doi:10.1590/s0004-27302009000100004 · Cited by 6
Distribution of Intraportally Implanted Microspheres and Fluorescent Islets in Mice
von Seth, E., Nyqvist, D., Andersson, A., Carlsson, P., Köhler, M., Mattsson, G., Nordin, A., Berggren, P., & Jansson, L. (2007) · Cell Transplantation · doi:10.3727/000000007783465055 · Cited by 6
Ravanan, R., Wong, S., Morgan, N. G., Mathieson, P. W., & Smith, R. M. (2007) · Clinical and Experimental Immunology · doi:10.1111/j.1365-2249.2007.03358.x · Cited by 6
Developing Humanized Animal Models with Transplantable Human iPSC-Derived Cells
Ma, M., Ge, J.-Y., Nie, Y., Li, Y., & Zheng, Y. (2024) · Frontiers in Bioscience-Landmark · doi:10.31083/j.fbl2901034 · Cited by 6
“For immunogenicity, ischemia-reperfusion [206] and inflammatory factors [207,208] known causes of clearance of implanted cells, 3D culture can reduce the expression of dedifferentiated inflammatory factors [38], immunosuppressive pretreatment before transplantation also can promote the engraftment…”
BackgroundHilburger, C. E., Rosenwasser, M. J., & Delcassian, D. (2022) · Journal of Immunology and Regenerative Medicine · doi:10.1016/j.regen.2022.100063 · Cited by 3
Porcine Islet Cell Xenotransplantation
Chinnuswami, R., Hussain, A., Loganathan, G., Narayanan, S., Porter, G. D., & Balamurugan, A. N. (2020) · IntechOpen eBooks · doi:10.5772/intechopen.90437 · Cited by 10
“Genetically modified pigs have been produced [110, 136] to combat IBMIR by decreasing the load of xenoantigens but it failed to provide long-term protection against host response [137].”
Hepatic hematoma after islet cell transplantation
Bozkurt, N., Peixoto, E., Froud, T., Herrada, E., Corrales, A., Ricordi, C., & Alejandro, R. (2013) · Transplantation · doi:10.1097/tp.0b013e31829468e2 · Cited by 5
Role of islet culture on angiogenic and inflammatory mechanisms.
Vivot, K., Jeandidier, N., Döllinger, C., Bietiger, W., Pinget, M., Sigrist, S., & Langlois, A. (2011) · Transplantation Proceedings · doi:10.1016/j.transproceed.2011.09.096 · Cited by 5
Islet vs pancreas transplantation in nonuremic patients with type 1 diabetes
Zarinsefat, A., & Stock, P. G. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814833-4.00034-4 · Cited by 9
Islet and Pancreas Transplantation
Ciancio, G., Pugliese, A., Burke, G. W., & Ricordi, C. (2009) · Humana Press eBooks · doi:10.1007/978-1-60327-478-4_23 · Cited by 3
“Peritransplant anticoagulant prophylaxis with heparin can counteract this reaction (Moberg et al., 2002; Johansson et al., 2005; Eich et al., 2007).”
BackgroundAdler, A., Fritsch, M., Fromell, K., Leneweit, G., Ekdahl, K., Nilsson, B., & Teramura, Y. (2023) · Journal of materials chemistry. B · doi:10.1039/d3tb01721d · Cited by 4
Self-citationPerioperative Coagulation Changes in Total Pancreatectomy and Islet Auto-Transplantation
Bergman, Z. R., Robbins, A., Alwan, F. S., Bellin, M., Kirchner, V., Pruett, T., Mulier, K., Boucher, A., Lusczek, E., & Beilman, G. (2022) · Pancreas · doi:10.1097/mpa.0000000000002085 · Cited by 4
Hoang, D. M., Nguyen, K. T., Hoang, V. T., Dao, L. T. M., Bui, H. T. T., Ho, T. T. K., Nguyen, T. T. P., Ngo, A. T., Nguyen, H. K., & Thanh, L. N. (2021) · The Journals of Gerontology Series A · doi:10.1093/gerona/glab326 · Cited by 6
“(v) The expression of CD142 in different MSC products is associated with their procoagulant nature, which triggers instant blood-mediated inflammatory reactions via complex cascades of immunological reactions (15).”
BackgroundChabert, C., Laporte, C., Fertin, A., Tubbs, E., Cottet-Rousselle, C., Rivera, F., Orhant-Prioux, M., Moisan, A., Fontaine, E., Benhamou, P., et al. (2018) · Frontiers in Endocrinology · doi:10.3389/fendo.2018.00272 · Cited by 4
Xenotransplantation of the endocrine pancreas
Smood, B. F., Bottino, R., & Cooper, D. K. C. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-814831-0.00031-2 · Cited by 5
APOPTOSIS OF HUMAN FETAL PANCREATIC ISLETS DURING SHORT-TERM CULTURE
Djordjević, P., Dimitrijevic-Sreckovic, V., Bumbaširević, V., Čolović, R., Nikolic, D., Raketic, N., & Canović, F. (2009) · doi:10.2298/abs0901009d · Cited by 4
“These results were confirmed in some very experienced centers (Tanioka et al., 1997; Moberg et al., 2002; Ozmen et al., 2002; Shapiro et al., 2003), but not elsewhere (Ault, 2003).”
ResultNavigating challenges in human pluripotent stem cell-derived islet therapy for type 1 diabetes
Usama, M., Deng, Y., Chen, Y., Milland, T., Malleshaiah, M. K., & Aghazadeh, Y. (2025) · Frontiers in Immunology · doi:10.3389/fimmu.2025.1625439 · Cited by 4
“Non-speci fi c immune mechanisms such as in fl ammation, hypoxia-induced cytokine production, and thrombotic reactions can also cause acute or progressive islet loss (103, 104).”
Shu, Y., Otake, M., Seta, Y., Hori, K., Kuramochi, A., Ohba, Y., & Teramura, Y. (2024) · Scientific Reports · doi:10.1038/s41598-024-66213-8 · Cited by 2
Naqvi, R., & Naqvi, A. (2023) · bioRxiv · doi:10.1101/2023.01.24.525444 · Cited by 3
Short-term inhalation of isoflurane improves the outcomes of intraportal hepatocyte transplantation
Nishimaki, H., Saitoh, Y., Inagaki, A., Nakamura, Y., Imura, T., Fathi, I., Yamana, H., Ohashi, K., Miyagi, S., Kamei, T., et al. (2022) · Scientific Reports · doi:10.1038/s41598-022-08237-6 · Cited by 3
Characterizing and overcoming innate immunity in beta-cell replacement therapy
Kumano, K., Vasu, S., Shabbir, R., Darden, C., Lawrence, M. C., & Naziruddin, B. (2020) · Journal of Immunology and Regenerative Medicine · doi:10.1016/j.regen.2020.100034 · Cited by 3
Ali, H. M., Bellin, M. D., Boucher, A. A., Northup, E. F., Florek, E., Wilhelm, J. J., Downs, E. M., Schwarzenberg, S. J., & Chinnakotla, S. (2020) · Pancreas · doi:10.1097/mpa.0000000000001571 · Cited by 4
“Many studies have demonstrated the induction of IBMIR in xenogenic and allogenic islet transplantation.(11,12) Naziruddin et al(7) published the first study demonstrating induction of IBMIR in the context of autologous islet transplantation.”
BackgroundLiljebäck, H., Quách, M., Carlsson, P., & Lau, J. (2019) · Cell Transplantation · doi:10.1177/0963689719866685 · Cited by 3
Clinical Islet Cell Transplantation – Recent Advances
Saravanan, P., Loganathan, G., Naziruddin, B., & Balamurugan, A. (2017) · doi:10.18520/cs/v113/i07/1267-1276 · Cited by 3
Human Endothelial Protein C Receptor Overexpression Protects Intraportal Islet Grafts in Mice.
Gock, H., Lee, K. F. E., Murray-Segal, L., Mysore, T., d'Apice, A., Salvaris, E., & Cowan, P. (2016) · Transplantation Proceedings · doi:10.1016/j.transproceed.2016.02.080 · Cited by 3
Long‐term Outcomes after Islet Transplantation
Shapiro, A. M. J., & Ricordi, C. (2014) · Wiley eBooks · doi:10.1002/9781118873434.ch108 · Cited by 3
Genetic manipulation of islet cells in autoimmune diabetes: from bench to bedside.
Chuang, Y.-P., Chu, C., & Sytwu, H. (2008) · Frontiers in Bioscience · doi:10.2741/3144 · Cited by 3
“It has also been suggested that non-immune mediated physiological stress such as hypoxia, ROS or instant bloodmediated inflammatory reaction (IBMIR) induces platelet activation, clot formation and performs the initial wave of islet graft demise (147, 148).”
BackgroundIslet xenotransplantation: progress towards a clinical therapy
O'Connell, P., Lew, A., Cowan, P., Londrigan, S. L., Hawthorne, W., Nottle, M., & d'Apice, A. (2006) · doi:10.1097/01.mot.0000218932.27397.19 · Cited by 3
Current status of clinical islet transplantation: advances and obstacles
Wiseman, A. C., & Gill, R. G. (2004) · Current Opinion in Endocrinology & Diabetes · doi:10.1097/01.med.0000129642.42263.66 · Cited by 3
Engineering strategies of islet products for endocrine regeneration
Cheng, Y., & Zhao, G. (2023) · Engineered Regeneration · doi:10.1016/j.engreg.2023.01.003 · Cited by 2
Function and Gene Expression of Islets Experimentally Transplanted to Muscle and Omentum
Espes, D., Liljebäck, H., Franzén, P., Quách, M., Lau, J., & Carlsson, P. (2020) · Cell Transplantation · doi:10.1177/0963689720960184 · Cited by 2
Gustafson, E., Hamad, O., Deckmyn, H., Barbu, A., Ekdahl, K., & Nilsson, B. (2019) · Transplantation · doi:10.1097/tp.0000000000002707 · Cited by 2
Self-citationA novel model for studies of blood-mediated long-term responses to cellular transplants
Hårdstedt, M., Lindblom, S., Hong, J., Nilsson, B., Korsgren, O., & Ronquist, G. (2015) · Upsala Journal of Medical Sciences · doi:10.3109/03009734.2014.965290 · Cited by 2
“This reaction starts with an immediate thrombotic and inflammatory reaction with activation of complement and coagulation cascades together with platelet aggregation, and is believed to cause a deleterious rapid loss of transplanted islets prior to engraftment (3,11,12).”
BackgroundSelf-citationRecent Progress in Clinical Islet Transplantation
Park, J., & Kim, S. J. (2014) · Hanyang Medical Reviews · doi:10.7599/hmr.2014.34.4.173 · Cited by 2
McCall, M., & Shapiro, A. M. J. (2014) · Seminars in Pediatric Surgery · doi:10.1053/j.sempedsurg.2014.03.006 · Cited by 36
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“Instant blood-mediated inflammatory reaction is initiated upon intraportal infusion of islets.(7) The present study indicated that the blood glucose levels re-elevate 2 days after islet transplantation.”
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Chen, J., Zheng, Q., & Huang, X.-Y. (2007) · doi:10.3760/cma.j.issn.1673-4203.2007.09.015 · Cited by 2
The continuing progress and challenges of clinical islet transplantation
Wiseman, A., & Gill, R. (2005) · doi:10.1097/01.med.0000170499.89309.cb · Cited by 2
Treating diabetes with islet transplantation: Lessons from the Milan experience
Piemonti, L., Maffi, P., Nano, R., Bertuzzi, F., Melzi, R., Mercalli, A., Caldara, R., Antonioli, B., Magistretti, P., Venturini, M., et al. (2020) · doi:10.1016/b978-0-12-814833-4.00052-6 · Cited by 2
Islet Cell or Pancreas Transplantation
Piemonti, L., Socci, C., Nano, R., Maffi, P., & Secchi, A. (2018) · Endocrinology · doi:10.1007/978-3-319-45015-5_23 · Cited by 2
Beta Cell Imaging as Part of “Imaging on Metabolic Diseases”
Brom, M., Eter, W. A., van der Kroon, I., Willekens, S. M. A., Eek, A., Boss, M., Buitinga, M., & Gotthardt, M. (2017) · doi:10.1007/978-3-319-42202-2_24 · Cited by 2
Jabri, A., Alsharif, M., Taftafa, B., Abbad, T., Sibai, D., Mhannayeh, A., Elsalti, A., Saadeldin, I. M., Salma, J., Mir, T. A., et al. (2026) · Bioengineering · doi:10.3390/bioengineering13040478 · Cited by 2
“Traditional pancreatic tissue biopsies carry a substantial risk of morbidity, including pancreatitis, hemorrhage, and leakage [104,105].”
Kazmi, S., Tarique, M., Badal, D., Ulker, V., Turan, A., Yee-Flores, K. M., Nejma, A. J., Yolcu, E., & Shirwan, H. (2026) · JCI Insight · doi:10.1172/jci.insight.200686 · Cited by 1
“Islet grafts contribute to their own demise by expressing tissue factor (TF), various danger-associated molecular patterns, and proinflammatory cytokines and chemokines that collectively lead to the activation of coagulation, complement, and innate immune pathways (20–22).”
The Transplantation of Pancreatic Islets to Portal Vein: The Influence on Liver Tissue
Vojtíšková, A., Fábryová, E., Berková, Z., Koblas, T., Girman, P., & Kříž, J. (2026) · International Journal of Molecular Sciences · doi:10.3390/ijms27031419 · Cited by 2
A novel approach for hepatocyte transplantation at the liver surface
Katano, T., Inagaki, A., Imura, T., Yamana, H., Saito, R., Kumata, Y. E., Suzuki, S., Hagiwara, Y., Ohashi, K., Watanabe, K., et al. (2025) · Cell Transplantation · doi:10.1177/09636897251329308 · Cited by 1
“…of HTx. Exposure of hepatocytes to the circulating bloodstream is known to induce an instant blood-mediated inflammatory reaction (IBMIR), in which exposure of tissue factors expressed on the surface of the hepatocytes to portal vein flow activates coagulation and complement cascades 15,16 .”
Comprehensive analysis of gene expression of isolated pancreatic islets during pretransplant culture
Haga, J., Sato, N., Anazawa, T., Kimura, T., Kenjo, A., Gotoh, M., & Marubashi, S. (2021) · Fukushima Journal of Medical Science · doi:10.5387/fms.2020-25 · Cited by 1
Chen, C.-G., Rawat, D., Samikannu, B., Bender, M., Preissner, K., & Linn, T. (2020) · American Journal of Transplantation · doi:10.1111/ajt.16375 · Cited by 1
Lee, D., Gillard, P., Hilbrands, R., Ling, Z., de Velde, U. V., Jacobs‐Tulleneers‐Thevissen, D., Maleux, G. A., Lapauw, B., Crenier, L., Block, C. E. M. D., et al. (2020) · Transplantation · doi:10.1097/tp.0000000000003321 · Cited by 1
“Human pancreatic duct cells are known to exert tissue-factor dependent procoaglulant activity(36) and to express CD40,(37) which are both linked to instant blood–mediated inflammatory responses and cell death.(38) In vitro human data from Ramnath et al(39) suggest that short-term culture already reduces the instant bl…”
BackgroundA20 is an immune tolerance factor that can determine islet transplant outcomes
Zammit, N., Walters, S. N., Seeberger, K., Korbutt, G., & Grey, S. T. (2019) · bioRxiv · doi:10.1101/770834 · Cited by 1
“tissue factor (TF) (Figure 5D), which plays a critical role in triggering posttransplant 200 coagulation and enhances islet graft loss (39, 40).”
BackgroundKim, Y., Lee, W., & Park, C. (2016) · Journal of Bacteriology and Virology · doi:10.4167/jbv.2016.46.1.1 · Cited by 2
IPITA 2013 Abstracts Supplement
Vantyghem, M., Quintin, D., Karrouz, W., Hurtevent, J., Raverdy, V., Caiazzo, R., Noel, C., Kerr-Conte, J., Pattou, F., Messinger-Cayetano, S., et al. (2013) · doi:10.1097/tp.0b013e3182a7ab68 · Cited by 1
Pancreatic islet transplantation to the liver: how can vascularization problems be resolved?
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Gray, D. W. R. (2004) · Xenotransplantation · doi:10.1111/j.1399-3089.2004.00156.x · Cited by 1
“Because this phenomenon can be studied in vitro, considerable progress has been made towards elucidating its etiology [9] and approaches by which it may be halted [10], although information in an important ’’control’’, namely the ability of autogenous fresh primate blood to damage islets is still lacking.”
BackgroundLa greffe d’îlots pancréatiques
Benhamou, P., & Bayle, F. (2004) · La Presse Médicale · doi:10.1016/s0755-4982(04)98807-0 · Cited by 1
Cellular therapies in preclinical and clinical islet transplantation: Mesenchymal stem cells
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“…kidney allocation, islets are often pooled or administered from multiple donors, donor availability is limited, immediate islet quality and islet mass strongly in fl uence success, and early IBMIR and engraftment failure compete with adaptive alloimmunity as causes of graft loss (6, 15 – 18).”
Hoang, V. H., Nguyen, Q. T., Le, D. S., Ngo, L. A. T., & Nguyen, L. T. (2026) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2026.1911520
“For the first time, Bennet and Moberg described the IBMIR, which is associated with activation of the coagulation and complement systems, resulting in graft failure and TF/CD142-induced thrombosis upon pancreatic islet transplantation (Bennet et al., 2000; Moberg et al., 2002).”
Nonnarath, C., & Serratrice, N. (2026) · Cell Transplantation · doi:10.1177/09636897261469003
“40 Such reactions may impair microvascular perfusion and contribute to early graft injury.”
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“IBMIR is also a well-known mechanism effecting islets and islet like cells, which can occur almost immediately or even up to hours after the islet infusion in the allo, auto and xenograft setting [43, 44].”
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Living Cells: Surface Modification
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“Peri-transplant anticoagulant prophylaxis with heparin can counteract this reaction (Moberg et al. 2002; Johansson et al. 2005; Eich et al. 2007).”
BackgroundKim, J. M., Jin, S.-M., Oh, S.-H., Lee, H.-S., Kim, J. H., Kwon, C., Kim, S. J., Joh, J., & Kim, K. (2012) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2011.10.044
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Metadata
- Authors
- Moberg, L., Johansson, H., Lukinius, A., Berne, C., Foss, A., Källen, R., Østraat, Ø., Salmela, K., Tibell, A., Tufveson, G., Elgue, G., Ekdahl, K. N., Korsgren, O., & Nilsson, B.
- Affiliations
- Uppsala University (SE)
- Uppsala University Hospital (SE)
- University of Helsinki (FI)
- Corresponding author
- Nilsson, B
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2002-12
- Volume
- 360
- Issue
- 9350
- Pages
- 2039-2045
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2158070939
- Cited by
- 568
- References
- 0
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 13 · 2023: 17 · 2022: 16 · 2021: 13 · 2020: 24 · 2019: 37 · 2018: 23 · 2017: 24 · 2016: 35 · 2015: 25 · 2014: 26 · 2013: 29 · 2012: 29
- FWCI
- 16.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Knut och Alice Wallenbergs Stiftelse
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- tissue factor, islet transplantation, type 1 diabetes, coagulation activation, islet damage, factor VIIa, islet endocrine cells, graft loss, insulin secretion
- MeSH terms
- Adult, Blood Cell Count, Diabetes Mellitus, Type 1, Female, Humans, Islets of Langerhans, Male, Middle Aged, Postoperative Complications, Precipitin Tests, Thromboplastin, Thrombosis, Islets of Langerhans Transplantation
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