title: Correlation between beta cell mass and glycemic control in type 1 diabetic recipients of islet cell graft.
abstract: Islet grafts can induce insulin independence in type 1 diabetic patients, but their function is variable with only 10% insulin independence after 5 years. We investigated whether cultured grafts with defined beta cell number help standardize metabolic outcome. Nonuremic C-peptide-negative patients received an intraportal graft with 0.5-5.0 x 10(6) beta cells per kilogram of body weight (kg BW) under antithymocyte globulin and mycophenolate mofetil plus tacrolimus. Metabolic outcome at posttransplant (PT) month 2 was used to decide on a second graft under maintenance mycophenolate mofetil/tacrolimus. Graft function was defined by C-peptide >0.5 ng/ml and reduced insulin needs, metabolic control by reductions in HbA(1c), glycemia coefficient of variation, and hypoglycemia. At PT month 2, graft function was present in 16 of 17 recipients of >2 x 10(6) beta cells per kg BW versus 0 of 5 with lower number. The nine patients with C-peptide >1 ng/ml and glycemia coefficient of variation of <25% did not receive a second graft; five of them were insulin-independent until PT month 12. The 12 others received a second implant; it achieved insulin-independence at PT month 12 when the first and second graft contained >2 x 10(6) beta cells per kg BW. Of the 20 recipients of at least one graft with >2 x 10(6) beta cells per kg BW, 17 maintained graft function and metabolic control up to PT month 12. At PT month 12, beta cell function in insulin-independent patients ranged around 25% of age-matched control values. Thus, 1-year metabolic control can be reproducibly achieved and standardized by cultured islet cell grafts with defined beta cell number.
authors.affiliation: Diabetes Research Center and Academisch Ziekenhuis, Vrije Universiteit Brussel, B-1090 Brussels, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: Keymeulen
authors.forename: Pieter
authors.initials: P
authors.lastname: Gillard
authors.forename: Chantal
authors.initials: C
authors.lastname: Mathieu
authors.forename: Babak
authors.initials: B
authors.lastname: Movahedi
authors.forename: Geert
authors.initials: G
authors.lastname: Maleux
authors.forename: Georges
authors.initials: G
authors.lastname: Delvaux
authors.forename: Dirk
authors.initials: D
authors.lastname: Ysebaert
authors.forename: Bart
authors.initials: B
authors.lastname: Roep
authors.forename: Evy
authors.initials: E
authors.lastname: Vandemeulebroucke
authors.forename: Miriam
authors.initials: M
authors.lastname: Marichal
authors.forename: Peter
authors.initials: P
authors.lastname: In 't Veld
authors.forename: Marika
authors.initials: M
authors.lastname: Bogdani
authors.forename: Christel
authors.initials: C
authors.lastname: Hendrieckx
authors.forename: Frans
authors.initials: F
authors.lastname: Gorus
authors.forename: Zhidong
authors.initials: Z
authors.lastname: Ling
authors.forename: Jon
authors.initials: J
authors.lastname: van Rood
authors.forename: Daniel
authors.initials: D
authors.lastname: Pipeleers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000473:pathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000378:metabolism / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D016035:Pancreas Transplantation / Q000009:adverse effects; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin