Pancreas‐After‐Islet Transplantation in Nonuremic Type 1 Diabetes: A Strategy for Restoring Durable Insulin Independence. Issue 9 (6th June 2017)

• Record Type: Journal Article
• Authors: Wisel, S. A.; Gardner, J. M.; Roll, G. R.; Harbell, J.; Freise, C. E.; Feng, S.; Kang, S. M.; Hirose, R.; Kaufman, D. B.; Posselt, A. M.; Stock, P. G.
• Is Part Of: American journal of transplantation. Volume 17:Issue 9(2017)
• Page Start: 2444
• Page End: 2450
• Publication Date: 2017-06-06
• Subjects: clinical research/practice -- pancreas/simultaneous pancreas‐kidney transplantation -- islet transplantation -- diabetes: type 1 -- patient characteristics -- protocol biopsy -- immunosuppressive regimens; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.14344
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Islet transplantation offers a minimally invasive approach for β cell replacement in diabetic patients with hypoglycemic unawareness. Attempts at insulin independence may require multiple islet reinfusions from distinct donors, increasing the risk of allogeneic sensitization. Currently, solid organ pancreas transplant is the only remaining surgical option following failed islet transplantation in the United States; however, the immunologic impact of repeated exposure to donor antigens on subsequent pancreas transplantation is unclear. We describe a case series of seven patients undergoing solid organ pancreas transplant following islet graft failure with long‐term follow‐up of pancreatic graft survival and renal function. Despite highly variable panel reactive antibody levels prior to pancreas transplant (mean 27 ± 35%), all seven patients achieved stable and durable insulin independence with a mean follow‐up of 6.7 years. Mean hemoglobin A1c values improved significantly from postislet, prepancreas levels (mean 8.1 ± 1.5%) to postpancreas levels (mean 5.3 ± 0.1%; p = 0.0022). Three patients experienced acute rejection episodes that were successfully managed with thymoglobulin and methylprednisolone, and none of these preuremic type 1 diabetic recipients developed stage 4 or 5 chronic kidney disease postoperatively. These results support pancreas‐after‐islet transplantation with aggressive immunosuppression and protocol biopsies as a viable strategy to restore insulin independence after islet graft failure. Abstract : This observational study explores pancreas‐after‐islet transplantation as a modality to re‐establish insulin independence following failed islet transplant, with all patients achieving and maintaining insulin independence at a mean of 6.7 years posttransplant.