title: Islet autotransplant outcomes after total pancreatectomy: a contrast to islet allograft outcomes.
abstract: BACKGROUND
  Islet allografts are currently associated with a high rate of early insulin independence, but after 1 year insulin-independence rates rapidly decline for unclear reasons. In contrast, as shown here, islet autotransplants (IATs) show durable function and extended insulin-independence rates, despite a lower beta-cell mass.
  
  
  METHODS
  IAT function was determined in 173 patients after total pancreatectomy at our center. Islet function was considered full in insulin-independent patients, partial when euglycemic on once-daily long-acting insulin (all tested were C-peptide positive), and failed if on a standard diabetic regimen. Outcomes for autoislet recipients by Kaplan-Meier survival analysis were compared with those of alloislet recipients in the Collaborative Islet Transplant Registry.
  
  
  RESULTS
  IAT function (full/partial combined) and insulin independence correlated with islet yield. Overall only 65% functioned within the first year, and only 32% were insulin independent, but of IATs that functioned initially (n=112), 85% remained so 2-years later, in contrast to 66% of allografts (n=262). Of IAT recipients who became insulin independent (n=55), 74% remained so 2-years later versus 45% of initially insulin-independent allograft recipients (n=154). Of IATs that functioned or induced insulin independence, the rates at 5 years were 69% and 47%, respectively.
  
  
  CONCLUSIONS
  Islet function is more resilient in autografts than allografts. Indeed, the 5-year insulin-independence persistence rate for IATs is similar to the 2-year rate for allografts. Several factors unique to allocases are likely responsible for the differences, including donor brain death, longer cold ischemia time, diabetogenic immunosuppression, and auto- and alloimmunity. IAT outcomes provide a minimum theoretical standard to work toward in allotransplantation.
authors.affiliation: Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, MN 55455, USA.
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.forename: Angelika C
authors.initials: AC
authors.lastname: Gruessner
authors.forename: Annelisa M
authors.initials: AM
authors.lastname: Carlson
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Blondet
authors.forename: A N
authors.initials: AN
authors.lastname: Balamurugan
authors.forename: Katie F
authors.initials: KF
authors.lastname: Reigstad
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Beilman
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
authors.forename: Bernhard J
authors.initials: BJ
authors.lastname: Hering
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007328:Insulin / Q000378:metabolism / Q000627:therapeutic use; D000078790:Insulin Secretion; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D010180:Pancreatectomy / Q000379:methods; D012189:Retrospective Studies; D016019:Survival Analysis; D014182:Transplantation, Autologous / Q000502:physiology*; D014184:Transplantation, Homologous / Q000502:physiology*; D016896:Treatment Outcome
chemical_list: D007328:Insulin