title: Single-donor islet transplantation and long-term insulin independence in select patients with type 1 diabetes mellitus.
abstract: BACKGROUND
  Islet transplantation is a recognized treatment option for select patients with type I diabetes mellitus. However, islet infusions from multiple donors are often required to achieve insulin independence. Ideally, insulin independence would be achieved routinely with only a single donor. Identification of factors associated with insulin independence after single-donor islet transplantation may help to select recipient-donor combinations with the highest probability of success.
  
  
  METHODS
  Subjects undergoing islet transplantation at a single center (Edmonton, Canada) between March 1999 and August 2013 were included. Recipient, donor, and transplant characteristics were collected and compared between recipients who became insulin independent after one islet transplantation and those who did not.
  
  
  RESULTS
  Thirty-one patients achieved insulin independence after a single-donor islet transplantation, and 149 did not. Long-term insulin-free survival was not different between the groups. Factors significantly associated with single-donor success included recipient age, insulin requirement at baseline, donor weight, donor body mass index, islet transplant mass, and peritransplant heparin and insulin administration. On multivariate analysis, pretransplantation daily insulin requirements, the use of peritransplantation heparin and insulin infusions, and islet transplant mass remained significant.
  
  
  CONCLUSIONS
  We have identified clinically relevant differences defining the achievement of insulin independence after single-donor transplantation. Based on these differences, a preoperative insulin requirement of less than 0.6 U/kg per day and receiving more than 5,646 islet equivalents (IEQ)/kg have a sensitivity of 84% and 71% and specificity of 50% and 50%, respectively, for insulin independence after single-donor islet transplantation. With ideal patient selection, this finding could potentially increase single-donor transplantation success and may be especially relevant for presensitized subjects or those who may subsequently require renal replacement.
authors.affiliation: 1 Clinical Islet Transplant Program, Alberta Diabetes Institute and Department of Surgery, University of Alberta, Edmonton, Alberta, Canada. 2 St. George's University, University Centre, Grenada, West Indies. 3 Center for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada. 4 Clinical Islet Transplant Program and Alberta Diabetes Institute, University of Alberta, Edmonton, Alberta, Canada. 5 Address correspondence to: A.M. James Shapiro, M.D., Ph.D., University of Alberta, 2000 College Plaza, 8215-112 St, Edmonton, AB T6G 2C8.
authors.forename: David P
authors.initials: DP
authors.lastname: Al-Adra
authors.forename: Richdeep S
authors.initials: RS
authors.lastname: Gill
authors.forename: Sharleen
authors.initials: S
authors.lastname: Imes
authors.forename: Doug
authors.initials: D
authors.lastname: O'Gorman
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kin
authors.forename: Sara J
authors.initials: SJ
authors.lastname: Axford
authors.forename: Xinzhe
authors.initials: X
authors.lastname: Shi
authors.forename: Peter A
authors.initials: PA
authors.lastname: Senior
authors.forename: A M James
authors.initials: AM
authors.lastname: Shapiro
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007328:Insulin / Q000032:analysis / Q000627:therapeutic use; D007515:Islets of Langerhans / Q000166:cytology* / Q000276:immunology; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007328:Insulin; D006493:Heparin