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

Abstract

The aim of this study was to assess safety and efficacy of islet transplantation after initial pancreas transplantation with subsequent organ failure. Patients undergoing islet transplantation at our institution after pancreas organ failure were compared to a control group of patients with pancreas graft failure, but without islet transplantation and to a group receiving pancreas retransplantation. Ten patients underwent islet transplantation after initial pancreas transplantation failed and were followed for a median of 51 months. The primary end point of HbA1c <7.0% and freedom of severe hypoglycemia was met by nine of 10 patients after follow-up after islet transplantation and in all three patients in the pancreas retransplantation group, but by none of the patients in the group without retransplantation (n = 7). Insulin requirement was reduced by 50% after islet transplantation. Kidney function (eGFR) declined with a rate of -1.0 mL ± 1.2 mL/min/1.73 m 2 per year during follow-up after islet transplantation, which tended to be slower than in the group without retransplantation (P = .07). Islet transplantation after deceased donor pancreas transplant failure is a method that can safely improve glycemic control and reduce the incidence of severe hypoglycemia and thus establish similar glycemic control as after initial pancreas transplantation, despite the need of additional exogenous insulin. K E Y W O R D Sinsulin, islet transplantation, pancreas transplantation, type 1 diabetes mellitus

Bioartifizielle Bauchspeicheldrüse und Xenotransplantation

“…Die intraportale Inseltransplantation ist heute als wirksames Therapieverfahren für Patienten mit Typ-1-Diabetes und kritischer metabolischer Instabilität etabliert [1,2]. Eine breitere Anwendung ist aber infolge der unzureichenden Verfügbarkeit von Spenderorganen limitiert und wegen der Notwendigkeit einer dauerhaften Immunsuppression zur Abstoßungsprophylaxe für viele Patienten inadäquat.…”