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Pancreas After Failed Islet Transplantation; a Successful Strategy to Maintain Insulin Independence

J. Gardner,1 G. Roll,1 S. Wisel,1 J. Harbell,1 B. Hynson,1 D. Kaufman,2 A. Posselt,1 P. Stock.1

1Department of Surgery, University of California, San Francisco, San Francisco, CA
2Department of Surgery, University of Wisconsin, Madison, WI.

Meeting: 2015 American Transplant Congress

Abstract number: 232

Keywords: Insulin, Outcome, Sensitization

Session Information

Session Name: Concurrent Session: Optimizing Immunosuppression in Pancreas Transplantation

Session Type: Concurrent Session

Date: Monday, May 4, 2015

Session Time: 2:15pm-3:45pm

 Presentation Time: 3:15pm-3:27pm

Location: Room 119-B

Introduction: As islet transplantation (tx) remains an experimental and uninsured procedure, there are no established protocols to achieve insulin independence following failure of the islet transplant. The options are further limited by potential sensititization following exposure to multiple HLA antigens during islet infusions. We reviewed the long term success of solitary pancreas tx after failed islet tx.

Methods: Between 2006 and 2011, 6 PAI were performed in preuremic Type I diabetic recipients with prior history of hypoglycemic unawareness. Pancreas tx were performed with portal and enteric drainage. Immunosuppression included: thymoglobulin induction (6 mg/kg), maintenance with low dose tacrolimus (trough 5-7 ng/ml), MMF 1 gm/d, low-dose sirolimus (trough 5-7 ng/ml), and prednisone 5 mg/d. Protocol pancreas biopsies were performed between 3-4 months, or for clinical indication.

Results: All six recipients achieved insulin independence which was maintained in 100% of PAI at mean follow-up of approximately 5 years (69.3 months). Hgb AIC levels remained normalized (Table 1). Rejection episodes occured in 3/6 (50%) of the recipients.

PATIENT # OF ISLET INFUSIONS PANCREAS TRANSPLANT DATE pra AT TIME OF PANCREAS TRANSPLANT FOLLOWUP REJECTION EPISODES INSULIN INDEPENDENT? CURRENT HgbA1C
1 2 10/2006 91% 98 mo 1 Yes 4.9
2 2 8/2007 76% 88 mo 1 Yes 5.7
3 3 1/2008 0% 83 mo 0 Yes 5.0
4 1 8/2010 10% 52 mo 1 Yes 5.2
5 1 10/2010 < 10% 50 mo 0 Yes 5.4
6 2 3/2011 62% 45 mo 0 Yes 5.6

Conclusions: Rigorous immunosuppression and close monitoring with protocol biopsies resulted in excellent outcomes in this new category of PAI. Insulin independence and normalized Hbg A1C was achieved in all recipients regardless of pre-tx sensitization. Minimization of calcineurin inhibitors prevented deterioration of native renal function. PAI provides a succesfful strategy for achieving insulin independence in preuremic Type I diabetic patients with prior hypoglycemic unawareness and failed islet allografts.

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To cite this abstract in AMA style:

Gardner J, Roll G, Wisel S, Harbell J, Hynson B, Kaufman D, Posselt A, Stock P. Pancreas After Failed Islet Transplantation; a Successful Strategy to Maintain Insulin Independence [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/pancreas-after-failed-islet-transplantation-a-successful-strategy-to-maintain-insulin-independence/. Accessed June 2, 2025.

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