title: Kidney function after islet transplant alone in type 1 diabetes: impact of immunosuppressive therapy on progression of diabetic nephropathy.
abstract: OBJECTIVE
  Islet transplantation alone is an alternative for the replacement of pancreatic endocrine function in patients with type 1 diabetes. The aim of our study was to assess the impact of the Edmonton immunosuppressive protocol (tacrolimus-sirolimus association) on kidney function.
  
  
  METHODS
  Nineteen patients with type 1 diabetes and metabolic instability received islet transplantation alone and immunosuppressive therapy according to the Edmonton protocol. Serum creatinine (sCr), creatinine clearance (CrCl), and 24-h urinary protein excretion (UPE) were assessed at baseline and during a follow-up of 339 patient-months.
  
  
  RESULTS
  After islet transplantation we observed 1) sCr within the normal range in all but two patients in whom sCr increased immediately after islet transplantation, and despite withdrawal of immunosuppression, patients progressed to end-stage renal disease (ESRD); 2) CrCl remained within the normal range for those patients who had normal baseline values and decreased, progressing to ESRD in two patients with a decreased baseline CrCl; and 3) 24-h UPE worsened (>300 mg/24 h) in four patients. In the two patients who progressed to ESRD, the worsening of 24-h UPE occurred immediately after islet transplantation. In one patient 24-h UPE worsening occurred at 18 months, and, after withdrawal of immunosuppression, it returned to the normal range. In another patient 24-h UPE increased at 24 months and remained stable while immunosuppression was continued.
  
  
  CONCLUSIONS
  In type 1 diabetic patients receiving islet transplantation alone, the association of tacrolimus and sirolimus should be used only in patients with normal kidney function. Alternative options for immunosuppressive treatment should be considered for patients with even a mild decrease of kidney function.
authors.affiliation: Department of Medicine, Transplant Unit, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy. paola.maffi@hsr.it
authors.forename: Paola
authors.initials: P
authors.lastname: Maffi
authors.forename: Federico
authors.initials: F
authors.lastname: Bertuzzi
authors.forename: Francesca
authors.initials: F
authors.lastname: De Taddeo
authors.forename: Paola
authors.initials: P
authors.lastname: Magistretti
authors.forename: Rita
authors.initials: R
authors.lastname: Nano
authors.forename: Paolo
authors.initials: P
authors.lastname: Fiorina
authors.forename: Andrea
authors.initials: A
authors.lastname: Caumo
authors.forename: Paolo
authors.initials: P
authors.lastname: Pozzi
authors.forename: Carlo
authors.initials: C
authors.lastname: Socci
authors.forename: Massimo
authors.initials: M
authors.lastname: Venturini
authors.forename: Alessandro
authors.initials: A
authors.lastname: del Maschio
authors.forename: Antonio
authors.initials: A
authors.lastname: Secchi
mesh_terms: D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D003404:Creatinine / Q000097:blood; D000077561:Daclizumab; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology* / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000139:chemically induced* / Q000503:physiopathology*; D018450:Disease Progression; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007074:Immunoglobulin G / Q000009:adverse effects; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D007677:Kidney Function Tests; D012189:Retrospective Studies; D020123:Sirolimus / Q000009:adverse effects; D016559:Tacrolimus / Q000009:adverse effects
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D003404:Creatinine; D000077561:Daclizumab; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007074:Immunoglobulin G; D007166:Immunosuppressive Agents; D007328:Insulin; D020123:Sirolimus; D016559:Tacrolimus