Selection of diabetic patients for islet transplantation. A single-center experience.
OBJECTIVE
Since the Edmonton protocol, islet transplantation (IT) offers the prospect of adequate glycemic control with no major surgical risk. In our single-center experience of IT, we studied the recruitment of eligible diabetic patients.


METHODS
Between 1998 and 2002, we screened 79 diabetic patients that were divided into 2 groups according to their renal status: 41 were not receiving dialysis (ND) while 38 were receiving ongoing dialysis (D).


RESULTS
In the ND group, 20 patients initiated the contact with our team, 8 patients were recruited during hospitalization for very poor glycemic imbalance, and 13 were referred by their diabetologist. 14/41 (34%) patients were ineligible for IT either because of very good glycemic balance, detectable C-peptide (C-p), kidney or liver problems, or plans for future pregnancy. 16/41 (39%) did not wish to proceed, 7 of whom were more interested by a pump. 11/41 (27%) were eligible, among which 8 are currently being assessed, 1 is on the waiting list and 2 have been transplanted. In the D group, 17/38 (45%) had a detectable C-p and received a kidney graft alone. Among the remaining 21 C-p negative diabetic patients, 3 were not eligible for kidney transplantation mainly for psychological reasons, and 4 were enlisted for kidney+pancreas transplantation. The remaining 14 C-p negative patients were kidney-transplanted. Among them, 6 were not eligible for IT, mainly for lack of motivation, slightly positive C-p stimulation tests, obesity, cancer, or increased creatininemia. The remaining 8/14 C-p negative kidney-engrafted patients were enlisted for IT. 3 had secondary failure with the pre-Edmonton immunosuppressive (IS) protocol. Five have been transplanted with the Edmonton-like IS regimen.


CONCLUSIONS
Twenty-five per cent of the 79 patients for whom islet transplantation was considered underwent pregraft assessment and 12% (10 patients, 8 kidney-transplanted and 2 islet alone) of the 79 have been transplanted. The main eligibility criteria were undetectable Cpeptide, normal kidney function, average weight, glycemic imbalance, hypoglycemia unawareness, and glycemic brittleness.
Vantyghem
M C
MC
Endocrinology and Metabolism Department, INSERM ERIT-M 0106, Diabetes Cell Therapy Lille University Hospital, 59037 Lille, France.
Hazzan
M
M
Tourvieille
S
S
Provost
F
F
Perimenis
P
P
Declerck
N
N
Sergent
G
G
Kerr-Conte
J
J
Noel
C
C
Pattou
F
F
D000328:Adult; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000706:statistics & numerical data*; D007676:Kidney Failure, Chronic / Q000601:surgery; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
D015415:Biomarkers; D001786:Blood Glucose; D002096:C-Peptide