title: Attainment of metabolic goals in the integrated UK islet transplant program with locally isolated and transported preparations.
abstract: The objective was to determine whether metabolic goals have been achieved with locally isolated and transported preparations over the first 3 years of the UK's nationally funded integrated islet transplant program. Twenty islet recipients with C-peptide negative type 1 diabetes and recurrent severe hypoglycemia consented to the study, including standardized meal tolerance tests. Participants received a total of 35 infusions (seven recipients: single graft; 11 recipients: two grafts: two recipients: three grafts). Graft function was maintained in 80% at [median (interquartile range)] 24 (13.5-36) months postfirst transplant. Severe hypoglycemia was reduced from 20 (7-50) episodes/patient-year pretransplant to 0.3 (0-1.6) episodes/patient-year posttransplant (p < 0.001). Resolution of impaired hypoglycemia awareness was confirmed [pretransplant: Gold score 6 (5-7); 24 (13.5-36) months: 3 (1.5-4.5); p < 0.03]. Target HbA1c of <7.0% was attained/maintained in 70% of recipients [pretransplant: 8.0 (7.0-9.6)%; 24 (13.5-36) months: 6.2 (5.7-8.4)%; p < 0.001], with 60% reduction in insulin dose [pretransplant: 0.51 (0.41-0.62) units/kg; 24 (13.5-36) months: 0.20 (0-0.37) units/kg; p < 0.001]. Metabolic outcomes were comparable 12 months posttransplant in those receiving transported versus only locally isolated islets [12 month stimulated C-peptide: transported 788 (114-1764) pmol/L (n = 9); locally isolated 407 (126-830) pmol/L (n = 11); p = 0.32]. Metabolic goals have been attained within the equitably available, fully integrated UK islet transplant program with both transported and locally isolated preparations.
authors.affiliation: Institute of Cellular Medicine, Newcastle University, Newcastle, UK.
authors.forename: A M
authors.initials: AM
authors.lastname: Brooks
authors.forename: N
authors.initials: N
authors.lastname: Walker
authors.forename: A
authors.initials: A
authors.lastname: Aldibbiat
authors.forename: S
authors.initials: S
authors.lastname: Hughes
authors.forename: G
authors.initials: G
authors.lastname: Jones
authors.forename: J
authors.initials: J
authors.lastname: de Havilland
authors.forename: P
authors.initials: P
authors.lastname: Choudhary
authors.forename: G C
authors.initials: GC
authors.lastname: Huang
authors.forename: N
authors.initials: N
authors.lastname: Parrott
authors.forename: N W A
authors.initials: NW
authors.lastname: McGowan
authors.forename: J
authors.initials: J
authors.lastname: Casey
authors.forename: L
authors.initials: L
authors.lastname: Mumford
authors.forename: P
authors.initials: P
authors.lastname: Barker
authors.forename: K
authors.initials: K
authors.lastname: Burling
authors.forename: R
authors.initials: R
authors.lastname: Hovorka
authors.forename: M
authors.initials: M
authors.lastname: Walker
authors.forename: R M
authors.initials: RM
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Forbes
authors.forename: M K
authors.initials: MK
authors.lastname: Rutter
authors.forename: S
authors.initials: S
authors.lastname: Amiel
authors.forename: M J
authors.initials: MJ
authors.lastname: Rosenthal
authors.forename: P
authors.initials: P
authors.lastname: Johnson
authors.forename: J A M
authors.initials: JA
authors.lastname: Shaw
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D007328:Insulin / Q000378:metabolism; D007515:Islets of Langerhans / Q000166:cytology*; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin
keywords: Islet transplantation; islet transport; meal tolerance test; severe hypoglycemia