Single-Donor Islet Transplantation and Long-term Insulin Independence in Select Patients With Type 1 Diabetes Mellitus

Abstract

We have identified clinically relevant differences defining the achievement of insulin independence after single-donor transplantation. Based on these differences, a preoperative insulin requirement of less than 0.6 U/kg per day and receiving more than 5,646 islet equivalents (IEQ)/kg have a sensitivity of 84% and 71% and specificity of 50% and 50%, respectively, for insulin independence after single-donor islet transplantation. With ideal patient selection, this finding could potentially increase single-donor transplantation success and may be especially relevant for presensitized subjects or those who may subsequently require renal replacement.

Age and Early Graft Function Relate With Risk-Benefit Ratio of Allogenic Islet Transplantation Under Antithymocyte Globulin-Mycophenolate Mofetil-Tacrolimus Immune Suppression

“…is in line with the results of other groups (2,4,8,(17)(18)(19)(20)(21)(22)(23) which studied more heterogeneous groups of isletalone and islet-after-kidney transplantation recipients and/or using different immune suppression regimens.…”

THERAPY OF ENDOCRINE DISEASE: Islet transplantation for type 1 diabetes: so close and yet so far away

“…In 2014, Shapiro group et al reported a significant association between single-donor islet transplantation and long-term insulin independence with older age and lower insulin requirements prior to transplantation (76). Moreover, higher weight and BMI of the donor resulted in a higher isolated islet mass and significant association with single-donor transplantation (76). The effectiveness of pre-transplant administration of insulin and heparin has been shown on achievement of insulin independence in single-donor islet transplantation (76).…”

“…Moreover, higher weight and BMI of the donor resulted in a higher isolated islet mass and significant association with single-donor transplantation (76). The effectiveness of pre-transplant administration of insulin and heparin has been shown on achievement of insulin independence in single-donor islet transplantation (76).…”

“…The islet isolation success rate is affected by factors such as donor characteristics, pancreas preservation, enzyme solutions, and density gradients for purification. Donor characteristics such as weight and BMI (O30) significantly affect islet yield (76,77). Andres et al (78) have claimed that a major pancreas injury which involves the main pancreatic duct during procurement is significantly associated with lower islet yield.…”

Single-donor islet transplantation in type 1 diabetes: patient selection and special considerations

“…To establish an islet population capable of producing enough insulin for clinical effect, a large number of these cells (>5,600 islet equivalents/kg) must be transplanted 9. Post-transplant, the C-peptide level is used as a marker for graft survival as its production often outlasts insulin independence and overall clinical effect of the transplant.…”