title: Development of Autoimmune-Mediated β Cell Failure After Total Pancreatectomy With Autologous Islet Transplantation.
abstract: Total pancreatectomy with islet autotransplantation (TPIAT) is performed for definitive treatment of chronic pancreatitis; patients are not diabetic before surgery, or have C-peptide positive pancreatogenous diabetes. Thus, TPIAT recipients are not traditionally considered at risk for autoimmune loss of the islet graft. We describe a 43-year-old female who underwent TPIAT with high mass islet graft of 6031 IEQ/kg, with no evidence of presurgical β cell autoimmunity who developed type 1 diabetes within the first year after TPIAT, resulting in complete loss of beta cell function. The patient had positive GAD and insulin autoantibodies at 1 year and 18 months after TPIAT, not present prior, and undetectable C-peptide after mixed meal and intravenous glucose tolerance testing at 18 months. Glucagon secretion was preserved, suggesting the transplanted alpha cell mass was intact. HLA typing revealed a DR3/DR4 class II haplotype. This case highlights the need to consider de novo type 1 diabetes in patients with unexpected islet graft failure after TPIAT.
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, MN.|University of Minnesota, Schulze Diabetes Institute, Minneapolis, MN.
authors.forename: M D
authors.initials: MD
authors.lastname: Bellin
authors.affiliation: Department of Pediatrics, University of Minnesota, Minneapolis, MN.
authors.forename: A
authors.initials: A
authors.lastname: Moran
authors.affiliation: University of Minnesota, Schulze Diabetes Institute, Minneapolis, MN.
authors.forename: J J
authors.initials: JJ
authors.lastname: Wilhelm
authors.affiliation: University of Minnesota, College of Veterinary Medicine, St. Paul, MN.
authors.forename: T D
authors.initials: TD
authors.lastname: O'Brien
authors.affiliation: Barbara Davis Center for Childhood Diabetes, Aurora, CO.
authors.forename: P A
authors.initials: PA
authors.lastname: Gottlieb
authors.affiliation: Barbara Davis Center for Childhood Diabetes, Aurora, CO.
authors.forename: L
authors.initials: L
authors.lastname: Yu
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: T B
authors.initials: TB
authors.lastname: Dunn
mesh_terms: D000328:Adult; D015551:Autoimmunity; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000209:etiology* / Q000378:metabolism / Q000473:pathology; D006085:Graft Survival; D006801:Humans; D050417:Insulin-Secreting Cells / Q000473:pathology*; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects*; D010180:Pancreatectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D014182:Transplantation, Autologous
keywords: autoimmunity; autotransplantation; diabetes: type 1; insulin / C-peptide; islets of Langerhans