title: Impact of the number of infusions on 2-year results of islet-after-kidney transplantation in the GRAGIL network.
abstract: BACKGROUND
  Insulin independence after islet transplantation is generally achieved after multiple infusions. However, single infusion would increase the number of recipients. Our aim was to evaluate the results of islet-after-kidney transplantation according to the number of infusions.
  
  
  METHODS
  Islets were isolated at the Geneva University, shipped, and transplanted into French patients from the Swiss-French GRAGIL network, on the "Edmonton" immunosuppression protocol between 2004 and 2010.
  
  
  RESULTS
  Nineteen patients were transplanted with 33 preparations. Fifteen patients reached 24 months follow-up; eight subjects were single-graft recipients and seven were double-graft recipients. Finally, single-graft recipients received a median of 5312 islet equivalents/kg (5186-6388) vs. 10,564 (10,054-11,375) for double-graft recipients (P=0.0003) with similar islet mass at first infusion. Insulin independence was achieved in five of eight single-graft subjects (62.5%) versus five of seven in double-graft subjects (71.4%), not significant. Median insulin independence duration was 4.7 (3.1-15.2) months after one infusion vs. 19 (9.6-20.8) months after two infusions (not significant). At 24 months posttransplant, comparing single- with double-graft patients, insulin doses were 0.23 (0.11-0.34) U/kg vs. 0.02 (0.0-0.23) U/kg, P=0.11; HbA1c was 6.5% (5.9%-6.8%) vs. 6.2% (5.9%-6.3%), P=0.16; and basal C-peptide was 302 (143-480) pmol/L vs. 599 (393-806) pmol/L, P=0.05. Only 37.5% of single-graft patients had a β-score ≥4 compared with 100% of double-graft patients (P=0.03). Two recipients experienced postinfusion bleeding, and two patients (13%) showed renal dysfunction in the absence of biopsy-proven rejection.
  
  
  CONCLUSIONS
  One infusion achieves good glycemic control and sometimes insulin independence. However, double-graft patients remain insulin-free longer, tend to have lower HbA1c, and show better graft function 24 months after transplant.
authors.affiliation: Department of Surgery, Islet Isolation and Transplantation Center, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Sophie
authors.initials: S
authors.lastname: Borot
authors.forename: Nadja
authors.initials: N
authors.lastname: Niclauss
authors.forename: Anne
authors.initials: A
authors.lastname: Wojtusciszyn
authors.forename: Coralie
authors.initials: C
authors.lastname: Brault
authors.forename: Sandrine
authors.initials: S
authors.lastname: Demuylder-Mischler
authors.forename: Yannick
authors.initials: Y
authors.lastname: Müller
authors.forename: Laurianne
authors.initials: L
authors.lastname: Giovannoni
authors.forename: Géraldine
authors.initials: G
authors.lastname: Parnaud
authors.forename: Raphael
authors.initials: R
authors.lastname: Meier
authors.forename: Lionel
authors.initials: L
authors.lastname: Badet
authors.forename: François
authors.initials: F
authors.lastname: Bayle
authors.forename: Luc
authors.initials: L
authors.lastname: Frimat
authors.forename: Laurence
authors.initials: L
authors.lastname: Kessler
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Morelon
authors.forename: Alfred
authors.initials: A
authors.lastname: Penfornis
authors.forename: Charles
authors.initials: C
authors.lastname: Thivolet
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.forename: Domenico
authors.initials: D
authors.lastname: Bosco
authors.forename: Cyrille
authors.initials: C
authors.lastname: Colin
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Benhamou
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
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; D005602:France; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000379:methods* / Q000502:physiology; D016030:Kidney Transplantation / Q000502:physiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D006442:Glycated Hemoglobin; D007328:Insulin; C517652:hemoglobin A1c protein, human