title: Recurrence of type 1 diabetes after simultaneous pancreas-kidney transplantation in the absence of GAD and IA-2 autoantibodies.
abstract: We report herein the patterns of type 1 diabetes recurrence in a simultaneous pancreas-kidney transplant (SPK) recipient, in the absence of rejection. A 38-year-old female underwent SPK for end-stage nephropathy secondary to type 1 diabetes. Fasting blood glucose, HbA1c, fructosamine, C-peptide and autoantibodies (GAD-65, IA-2) were monitored throughout follow-up. At 3.5 years post-SPK, HbA1c and fructosamine increased sharply, indicating loss of perfect metabolic control, despite C-peptide levels in the normal-high range. Exogenous insulin was restarted 4 months later. C-peptide levels abruptly fell and became undetectable at 5.5 years. Autoantibody levels, which were undetectable at the time of SPK, never converted to positivity. Pancreas retranspantation was performed at 6 years. The failed pancreas graft had a normal macroscopic appearance. On histology, there were no signs of cellular or humoral rejection in the kidney or pancreas. A selective peri-islet lymphocytic infiltrate was observed, together with near-total destruction of β cells. At 2.5 years post retransplantation, pancreatic graft function is perfect. This observation indicates unequivocally that pancreas graft can be lost to recurrence of type 1 diabetes in the absence of rejection. GAD-65 and IA-2 autoantibodies are not reliable markers of autoimmunity recurrence.
authors.affiliation: Division of Transplantation, Geneva University Hospitals and University of Geneva, School of Medicine, Geneva, Switzerland. michela.assalino@hcuge.ch
authors.forename: M
authors.initials: M
authors.lastname: Assalino
authors.forename: M
authors.initials: M
authors.lastname: Genevay
authors.forename: P
authors.initials: P
authors.lastname: Morel
authors.forename: S
authors.initials: S
authors.lastname: Demuylder-Mischler
authors.forename: C
authors.initials: C
authors.lastname: Toso
authors.forename: T
authors.initials: T
authors.lastname: Berney
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood / Q000276:immunology*; D015551:Autoimmunity; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000276:immunology / Q000601:surgery; D003928:Diabetic Nephropathies / Q000150:complications / Q000276:immunology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D005968:Glutamate Decarboxylase / Q000097:blood / Q000276:immunology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000276:immunology / Q000601:surgery*; D016030:Kidney Transplantation / Q000276:immunology*; D016035:Pancreas Transplantation / Q000276:immunology*; D012008:Recurrence; D012086:Reoperation
chemical_list: D001323:Autoantibodies; C096322:ICA512 autoantibody; D005968:Glutamate Decarboxylase