Simultaneous islet–kidney vs pancreas–kidney transplantation in type 1 diabetes mellitus: a 5 year single centre follow-up

Abstract

Aims/hypothesis The aim of this study was to compare the long-term outcomes-in terms of glucose control, renal function and procedure-related complications-of simultaneous islet-kidney (SIK) transplantation with those of simultaneous pancreas-kidney (SPK) transplantation in patients with type 1 diabetes mellitus. Methods HbA 1c , need for insulin, GFR and complication rate were compared between 13 recipients of SIK and 25 recipients of SPK transplants at the same institution. The mean follow-up was 41 months.Results Two primary organ non-functions occurred in the SIK group. HbA 1c did not differ at any time point during follow-up in the SIK group compared with the SPK group (mean during follow-up 6.3 vs 5.9%). Similarly, kidney function over time was not different between the two groups. A higher rate of insulin independence following SPK transplantation (after 1 year 96 vs 31% in the SIK group) was counterbalanced by a higher rate of serious adverse events (40% relaparotomies vs 0% in the SIK group). Conclusions/interpretation The endogenous insulin production achieved by islet transplantation, combined with optimal insulin therapy, was sufficient for maintaining near-normal glucose levels. In terms of glucose control, islet transplantation provides results comparable to those achieved with pancreas transplantation. However, SPK results in a higher rate of insulin independence, albeit at the cost of more surgical complications. These results have led to a new paradigm in islet transplantation at our institution, where the primary goal is not insulin independence, but good glucose control and avoidance of severe hypoglycaemia.

Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up

“…We reported a 5-year follow-up of patients who had undergone SPK transplantation versus those who had undergone SIK transplantation (10), and a comparison of pancreas versus islet transplantation alone was presented recently, but that study (11) did not include information on glycemic control.…”

Combined Kidney-Islet Transplantation

“…Moreover the cost is an additional important point in the context of repetitive islet transplantations. The same study reported that the cost of a combined kidney-islet transplantation is lower than the cost for a combined kidney-pancreas transplantation by about 10%, but exceeds in case two or more islet infusions have to be performed (Gerber et al, 2008).…”

“…A single infusion of functioning islets can reduce long term levels of HbA1c and consequently prevent the occurrence of severe asymptomatic episodes of hypoglycaemia and delay diabetes-related complications (Alejandro et al, 2008;Cure et al, 2008). The group of Zurich (Gerber et al, 2008) reported their own experience in the field of combined kidney-islet and kidney-pancreas transplantation. They compared the longterm outcomes of diabetic patients subjected to kidney-islets transplantation and treated with immunosuppression carried out according with the Edmonton protocol versus patients subjected to kidney-pancreas transplant treated with conventional immunosuppression.…”

“…Actually the patient selection for either two therapeutic options is performed after a careful evaluation of possible advantages and disadvantages, with special regard to age and comorbidities. Patients at high risk of intraoperative complications are preferentially assigned to the less invasive procedure of islet transplantation, while younger and healthier patients are generally addressed to pancreas transplantation (Gerber et al, 2008). In particular kidney-islets transplantation is preferred to kidney-pancreas for patients over 50 years of age or with severe macroangiopathy.…”

Simultaneous pancreas-kidney transplantation: The role in the treatment of type 1 diabetes and end-stage renal disease

“…In fact, glycemic control is far superior to that achieved by insulin pump or islet-cell transplants. 23 Mora and colleagues demonstrated that recipients achieved long-term normoglycemic state following SPK transplant. 24 During the 15-year follow-up, HbA1c level remained within the normal range with no significant difference between the first and the last year of follow-up (4.68% vs. 4.76%, p > 0.05).…”