Islet alone versus islet after kidney transplantation: metabolic outcomes and islet graft survival.
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.
Deng
Shaoping
S
Harrison Department of Surgical Research, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Markmann
James F
JF
Rickels
Micheal
M
Yeh
Heidi
H
Kim
James I
JI
Lian
Moh-Moh
MM
Gu
Yi
Y
Markmann
Eileen
E
Palanjian
Maral
M
Barker
Clyde F
CF
Naji
Ali
A
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
D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human