Glycemic Stability Through Islet‐After‐Kidney Transplantation Using an Alemtuzumab‐Based Induction Regimen and Long‐Term Triple‐Maintenance Immunosuppression. Issue 1 (19th August 2015)

• Record Type: Journal Article
• Authors: Nijhoff, M. F.; Engelse, M. A.; Dubbeld, J.; Braat, A. E.; Ringers, J.; Roelen, D. L.; van Erkel, A. R.; Spijker, H. S.; Bouwsma, H.; van der Boog, P. J. M.; de Fijter, J. W.; Rabelink, T. J.; de Koning, E. J. P.
• Is Part Of: American journal of transplantation. Volume 16:Issue 1(2016:Jan.)
• Page Start: 246
• Page End: 253
• Publication Date: 2015-08-19
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.13425
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Pancreatic islet transplantation is performed in a select group of patients with type 1 diabetes mellitus. Immunosuppressive regimens play an important role in long‐term islet function. We aimed to investigate the efficacy of islet transplantation in patients with type 1 diabetes and a previous kidney transplantation using an alemtuzumab‐based induction regimen and triple maintenance immunosuppression. Patients with type 1 diabetes, who had received a kidney transplant previously, were treated with alemtuzumab as induction therapy for their first islet transplantation and basiliximab induction therapy for subsequent islet transplantations. Maintenance immunosuppression consisted of triple immunosuppression (tacrolimus, mycophenolate mofetil, and prednisolone). Thirteen patients (age 50.9 ± 9.2 years, duration of diabetes 35 ± 9 years) received a total of 22 islet transplantations. One‐ and 2‐year insulin independence was 62% and 42%, respectively; graft function was 100% and 92%, respectively. HbA1c dropped from 57.2 ± 13.1 (7.4 ± 1.2%) to 44.5 ± 11.8 mmol/molHb (6.2 ± 0.9%) (p = 0.003) after 2 years. Six of 13 patients suffered from severe hypoglycemia before islet transplantation. After transplantation, severe hypoglycemia was restricted to the only patient who lost graft function. Creatinine clearance was unchanged. Islet‐after‐kidney transplantation in patients with type 1 diabetes using an alemtuzumab‐based induction regimen leads to considerable islet allograft function and improvement in glycemic control. Abstract : Alemtuzumab induction followed by triple maintenance immunosuppression in islet‐after‐kidney transplantation appears safe and leads to graft function with resolution of hypoglycemic events in 92% of patients and insulin independence in 42% of patients after 2 years.