Pancreas islet transplantation in patients with type 1 diabetes mellitus after kidney transplantation.
Diabetic patients with end-stage renal disease have a high mortality rate. A combined kidney-pancreas transplant is associated with greater life expectancy. Pancreas islet transplantation is an alternative involving a lower degree of morbidity. We present two patients, of 41 and 37 years of age, with a long history of diabetes mellitus (C-peptide negative), both with a previous kidney transplant, who had been treated with 22 and 28 U of insulin/d, respectively. Both patients had frequent episodes of unawareness hypoglycemia. Pancreatic islets were infused to a total of 7809 and 19,180 IE/kg, respectively. Basal posttransplant C peptide levels were 2.9 and 1.3 ng/mL. After the implant, one patient required occasional doses of insulin, and the other patient more than 50% reduced dose. After the first implant neither patient had any episodes of unawareness hypoglycemia. HbA1c at 4 months were 6.2% and 6.9%. There were no transplant-related complications.
Gonzalez Molina
M
M
Department of Nephrology, Hospital Carlos Haya, Malaga, Spain. cotraspa.hch.sspa@juntadeandalucia.es
Alonso
A
A
Briones
R
R
Fernandez
N
N
Caballero
A
A
Miranda
J M
JM
Navarro
A
A
Castro
M J
MJ
Burgos
D
D
Cabello
M
M
Sola
E
E
Escaño
A
A
Muñoz
J
J
Aranda
J
J
De la Fuente
A
A
D000328:Adult; D001364:Awareness; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000502:physiology*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period
D001786:Blood Glucose; D002096:C-Peptide; D007004:Hypoglycemic Agents; D007166:Immunosuppressive Agents; D007328:Insulin