title: Islet alone versus islet after kidney transplantation: metabolic outcomes and islet graft survival.
abstract: BACKGROUND
  Isolated islet transplantation with infusions from two to three donor pancreata and Edmonton immunosuppression consistently achieves insulin independence in patients with type 1 diabetes. The success of this protocol has been attributed to a novel combination of immunosuppressive agents and avoidance of steroids; however, the outcome of islet transplantation may differ in kidney transplant recipients who are already immunosuppressed.
  
  
  METHODS
  We compared the metabolic outcomes and graft survival of islet transplantation in our program where nine patients underwent islet transplantation alone treated with Edmonton immunosuppression and eight patients received islet after kidney (IAK) transplants under standard kidney transplant immunosuppression often including steroids.
  
  
  RESULTS
  Transplants in the IAK and islet transplantation alone setting demonstrated similar islet potency (islet equivalents/unit insulin reduction) and recipients from both groups routinely gained insulin independence, functional islet mass, and duration of graft survival, however, seemed superior in the IAK group.
  
  
  CONCLUSIONS
  These results suggest that better islet graft function and survival may be attained using non-Edmonton rather than Edmonton immunosuppression and can include maintenance steroid therapy.
authors.affiliation: Harrison Department of Surgical Research, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Shaoping
authors.initials: S
authors.lastname: Deng
authors.forename: James F
authors.initials: JF
authors.lastname: Markmann
authors.forename: Micheal
authors.initials: M
authors.lastname: Rickels
authors.forename: Heidi
authors.initials: H
authors.lastname: Yeh
authors.forename: James I
authors.initials: JI
authors.lastname: Kim
authors.forename: Moh-Moh
authors.initials: MM
authors.lastname: Lian
authors.forename: Yi
authors.initials: Y
authors.lastname: Gu
authors.forename: Eileen
authors.initials: E
authors.lastname: Markmann
authors.forename: Maral
authors.initials: M
authors.lastname: Palanjian
authors.forename: Clyde F
authors.initials: CF
authors.lastname: Barker
authors.forename: Ali
authors.initials: A
authors.lastname: Naji
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006085:Graft Survival / Q000502:physiology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007328:Insulin / Q000008:administration & dosage; D016381:Islets of Langerhans Transplantation / Q000379:methods* / Q000502:physiology*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013997:Time Factors
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human