Insulin-heparin infusions peritransplant substantially improve single-donor clinical islet transplant success.
BACKGROUND
Successful islet transplantation can result in insulin independence in many patients with type 1 diabetes mellitus, but it often requires more than one islet infusion. The ability to achieve insulin independence with a single donor is an important goal in clinical islet transplantation due to the limited organ supply.


METHODS
We examined factors that may be associated with insulin independence after islet transplantation with islets from a single donor, using univariate and multivariate analysis.


RESULTS
Thirteen of 85 (15.3%) achieved insulin independence after single-donor islet transplantation. Using multivariate analysis, only the use of insulin and heparin infusions peritransplant was a significant factor associated with insulin independence, with an adjusted odds ratio of 8.6 (95% confidence interval 2.0-37.0). Patients who had received insulin and heparin infusions peritransplant had greater indices of islet engraftment and a greater reduction in insulin use (80.1% + or - 4.3% vs. 54.2% + or - 2.8%, P<0.001) even if insulin independence was not achieved.


CONCLUSIONS
Peritransplant intensive insulin and heparin enhances islet transplantation outcomes likely related in part to mitigation of the effects of the instant blood-mediated inflammatory reaction, combined with islet rest and avoidance of inflammation. It would be important to further investigate the effects of peritransplant insulin and heparin infusions on islet engraftment.
Koh
Angela
A
1 Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada. 2 Division of Clinical Immunology, Department of Oncology, Radiology and Clinical Immunology, The Rudbeck Laboratory, Uppsala University, Uppsala, Sweden.
Senior
Peter
P
Salam
Abdul
A
Kin
Tatsuya
T
Imes
Sharleen
S
Dinyari
Parastoo
P
Malcolm
Andrew
A
Toso
Christian
C
Nilsson
Bo
B
Korsgren
Olle
O
Shapiro
A M James
AM
D000328:Adult; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D000991:Antithrombins / Q000032:analysis; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000601:surgery*; D004334:Drug Administration Schedule; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D016381:Islets of Langerhans Transplantation / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D019990:Perioperative Care / Q000379:methods*; D012044:Regression Analysis; D012189:Retrospective Studies; D013917:Thrombin / Q000032:analysis; D014019:Tissue Donors / Q000706:statistics & numerical data*; D016896:Treatment Outcome
D000925:Anticoagulants; D000991:Antithrombins; D001786:Blood Glucose; D006495:Heparin, Low-Molecular-Weight; D007004:Hypoglycemic Agents; D007328:Insulin; D013917:Thrombin