Islet-after-failed-pancreas and pancreas-after-failed islet transplantation: Two complementary rescue strategies to control diabetes

Abstract

(2015) Islet-after-failed-pancreas and pancreas-after-failed islet transplantation: Two complementary rescue strategies to control diabetes, Islets, 7:6, e1126036, DOI: 10.1080/19382014.2015 To link to this article: https://doi.org/10. 1080/19382014.2015 For selected patients with type 1 diabetes, b-cell replacement is the treatment of choice, either by islet transplantation (ITX) or whole pancreas transplantation (PTX). When either modality fails, current practice is to consider retransplantation, or return to exogenous insulin. We investigate outcomes with PTX after failed ITX (PAI), and ITX after failed PTX (IAP). All patients receiving PAI or IAP at a single institution were identified. Donor and recipient variables were documented, including transplant outcomes analyzed for insulin requirement and metabolic control. Five subjects were listed for PAI, and 2 received transplants. Of the 4 listed for IAP, 3 have received transplants. The mean waitlist time was 4.5 § 4.1 y for PAI and 0.35 §0 .4 y for IAP (p D 0.08). Metabolic control was excellent after PAI, with 2/2 insulin-independent. After IAP, 1/2 achieved insulin independence and good metabolic control after 2 islet infusions. The third could not receive 2 nd infusion and presented c-peptide levels < 0.1 nmol/L. Both strategies are feasible. The outcomes after PAI in our center must be offset by much longer waitlist time due to the sensitization status of these patients. Data from multicentre experience will allow more robust comparative outcomes to be made, the current observations being restricted to a limited patient set.

Islet transplantation as safe and efficacious method to restore glycemic control and to avoid severe hypoglycemia after donor organ failure in pancreas transplantation

“…A recent publication reported results of islet after combined or sequential pancreas‐kidney transplantation (as well as pancreas after islet transplantation) . However, this study included only three transplanted patients with a younger mean age (39.7 years).…”

“…A recent publication reported results of islet after combined or sequential pancreas-kidney transplantation (as well as pancreas after islet transplantation). 30 However, this study included only three transplanted patients with a younger mean age (39.7 years). There was only one older patient (52 years), and this patient showed persistent high blood glucose levels after islet transplantation (HbA1c 12.1% at the end of follow-up).…”

Expression of Imprinted Genes Kcnq1 and Cdkn1c During the Course of Differentiation from Mouse Embryonic Stem Cells into Islet-like Cells in vitro

“…Kcnq1 gene is also known as KvLQT1 [11]. It is reported that the Kcnq1 gene, expressed in various tissues of the body, has an important physiological role in regulating water and salt metabolism [12]. Kcnq1 and Cdkn1c are 2 adjacent imprinted genes that are expressed from the maternal [13].…”

Pancreas-After-Islet Transplantation in Nonuremic Type 1 Diabetes: A Strategy for Restoring Durable Insulin Independence

“…Even with minimal sensitization, patients with failed islet allografts who desperately desire a return to insulin independence have been largely excluded from pancreas transplant due to their immunologic risk. The increasing frequency of pancreas‐after‐islet (PAI) transplantation was recently reported using registry data and in a case report of two patients . Given the limiting constraints of registry data, PAI has not been studied for the effect of prior sensitization on graft or patient outcomes.…”