Durability of Pancreatic Islets Transplantation in Brittle Type 1 Diabetics- 10 Year Follow Up

Z. Tekin,¹ L. Schenck,¹ M. Garfinkel,⁵ L. Philipson,² J. Thistlethwaite,¹ W. Chon,² K. Golab,¹ O. Savari,¹ S. Ramachandran,¹ K. Rezania,³ S. Hariprasad,⁴ J. Millis,¹ P. Witkowski.¹

¹Surgery, University of Chicago, Chicago, IL
²Medicine, University of Chicago, Chicago, IL
³Neurology, University of Chicago, Chicago, IL
⁴Ophtalmology, University of Chicago, Chicago, IL
⁵Surgery, Southern Illinois University, Springfield, IL.

Meeting: 2015 American Transplant Congress

Abstract number: C199

Keywords: Immunosuppression, Islets, Sirolimus (SLR)

Session Information

Session Name: Poster Session C: More Controversies in Pancreas Transplantation

Session Type: Poster Session

Date: Monday, May 4, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

The aim of the study was to assess long-term results of the pancreatic islet transplantation in our center.

Methods: Human pancreatic islets were administered sequentially in up to 3 separate infusions with the goal of insulin independence. The immunosuppression protocol consisted of IL-2R antibody, rapamycin and tacrolimus.

Results: Four out of 9 (44%) enrolled patients completed the islet transplant protocol. Three patients of those are currently insulin-free 10, 9, 8 years after first infusion. Remaining patient was insulin free and lost islet function due to noncompliance 6 years after first transplant. Total islet mass infused was 19+/- 2 kIEQ/kg. Mean age and BMI was 46+/-3 and 22+/-1, respectively. In this cohort of patients, glycemic control improved dramatically, with elimination of hypoglycemic unawareness, lowering of HbA1C 8.4 to 5.9) and MAGE 5.5 to 1.7. None of these patients developed a positive PRA. Rapamycin was replaced with antimetabolites in 2 individuals and tacrolimus in remaining one due to side effects. None of patients developed proteinuria and average GFR did not change significantly. The neuropathy improved in two of the 4 patients, third developed a mild neuropathy and fourth patient remained stable without any signs of pathology.

There was a prolonged and stable improvement in QoL. One patient developed in situ breast cancer and basocellular skin cancer with full recovery after surgery and uncompromised islet graft function 9 years after initial transplant. Five remaining patients did not complete the transplant protocol. They dropped the study or they were withdrawn secondary to noncompliance, narcotic and alcohol abuse, and/or disappointment with the initial results.

Conclusion: Immunosuppression must be frequently adjusted to facilitate long-term islet survival and overall health of the recipients. Pancreatic islet transplantation offered durable long-term insulin free glycemic control in highly selected brittle diabetics without increased immunologic sensitization and kidney function compromise.

To cite this abstract in AMA style:

Tekin Z, Schenck L, Garfinkel M, Philipson L, Thistlethwaite J, Chon W, Golab K, Savari O, Ramachandran S, Rezania K, Hariprasad S, Millis J, Witkowski P. Durability of Pancreatic Islets Transplantation in Brittle Type 1 Diabetics- 10 Year Follow Up [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/durability-of-pancreatic-islets-transplantation-in-brittle-type-1-diabetics-10-year-follow-up/. Accessed November 23, 2024.

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