Intramuscular autotransplantation of pancreatic islets in a 7-year-old child: a 2-year follow-up.
A 7-year-old girl with severe hereditary pancreatitis underwent total pancreatectomy. A total of 160,000 islet equivalents (6400 islet/kg) were transplanted to the brachioradialis muscle of the right forearm. Her plasma C-peptide level was undetectable after pancreatectomy but increased to 1.37 ng/mL after 17 days; at this time point, her insulin requirement was 0.75 units of insulin/kg/day. At 5- and 27-months, her hemoglobin A1c (HbA1c) and insulin requirements were 4.5 and 5.3% and 0.3 and 0.18 units/kg/day, respectively. Basal and stimulated C-peptide levels were 0.67 +/- 0.07 and 3.36 +/- 1.37 ng/mL, respectively. Stimulated insulin levels were 30% higher in the islet-bearing arm compared to the contralateral arm after glucagon stimulation. After surgery and islet transplantation, the quality of life improved dramatically and she gained 8 kg of weight. In summary, a normal HbA1c, a low insulin requirement and the absence of recurrent hypoglycemia and the gradient of insulin between the arms indicate that the intramuscularly transplanted islets contribute to a long-term clinically significant metabolic control.
Rafael
E
E
Department of Surgery, Karolinska Institutet, Karolinska University Hospital in Huddinge, Stockholm, Sweden. ehab.rafael@karolinska.se
Tibell
A
A
Rydén
M
M
Lundgren
T
T
Sävendahl
L
L
Borgström
B
B
Arnelo
U
U
Isaksson
B
B
Nilsson
B
B
Korsgren
O
O
Permert
J
J
D002648:Child; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D018482:Muscle, Skeletal; D010180:Pancreatectomy; D010195:Pancreatitis / Q000235:genetics / Q000601:surgery*; D013997:Time Factors; D014182:Transplantation, Autologous / Q000379:methods*; D016896:Treatment Outcome
D006442:Glycated Hemoglobin