title: Glycemia, Hypoglycemia, and Costs of Simultaneous Islet-Kidney or Islet After Kidney Transplantation Versus Intensive Insulin Therapy and Waiting List for Islet Transplantation.
abstract: BACKGROUND
  Long-term data of patients with type 1 diabetes mellitus (T1D) after simultaneous islet-kidney (SIK) or islet-after-kidney transplantation (IAK) are rare and have never been compared to intensified insulin therapy (IIT).
  
  
  METHODS
  Twenty-two patients with T1D and end-stage renal failure undergoing islet transplantation were compared to 70 patients matched for age and diabetes duration treated with IIT and to 13 patients with kidney transplantation alone or simultaneous pancreas-kidney after loss of pancreas function (waiting list for IAK [WLI]). Glycemic control, severe hypoglycemia, insulin requirement, and direct medical costs were analyzed.
  
  
  RESULTS
  Glycated hemoglobin decreased significantly from 8.2 ± 1.5 to 6.7 ± 0.9% at the end of follow-up (mean 7.2 ± 2.5 years) in the SIK/IAK and remained constant in IIT (7.8 ± 1.0% and 7.6 ± 1.0) and WLI (7.8 ± 0.8 and 7.9 ± 1.0%). Daily insulin requirement decreased from 0.53 ± 0.15 to 0.29 ± 0.26 U/kg and remained constant in IIT (0.59 ± 0.19 and 0.58 ± 0.23 U/kg) and in WLI (0.76 ± 0.28 and 0.73 ± 0.11 U/kg). Severe hypoglycemia dropped in SIK/IAK from 4.5 ± 9.7 to 0.3 ± 0.7/patient-year and remained constant in IIT (0.1 ± 0.7 and 0.2 ± 0.8/patient-year). Detailed cost analysis revealed US $57,525 of additional cost for islet transplantation 5 years after transplantation. Based on a 5- and 10-year analysis, cost neutrality is assumed to be achieved 15 years after transplantation.
  
  
  CONCLUSIONS
  This long-term cohort with more than 7 years of follow-up shows that glycemic control in patients with T1D after SIK/IAK transplantation improved, and the rate of severe hypoglycemia decreased significantly as compared to control groups. Cost analysis revealed that islet transplantation is estimated to be cost neutral at 15 years after transplantation.
authors.affiliation: 1 Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital Zurich, Switzerland. 2 Division of Transplantation Surgery, University Hospital Zurich, Switzerland. 3 Division of Endocrinology, Diabetology and Osteology, Cantonal Hospital of St. Gallen, Switzerland.
authors.forename: Philipp A
authors.initials: PA
authors.lastname: Gerber
authors.forename: Rebecca
authors.initials: R
authors.lastname: Locher
authors.forename: Richard A
authors.initials: RA
authors.lastname: Zuellig
authors.forename: Oliver
authors.initials: O
authors.lastname: Tschopp
authors.forename: Evelyne
authors.initials: E
authors.lastname: Ajdler-Schaeffler
authors.forename: Philipp
authors.initials: P
authors.lastname: Kron
authors.forename: Christian
authors.initials: C
authors.lastname: Oberkofler
authors.forename: Michael
authors.initials: M
authors.lastname: Brändle
authors.forename: Giatgen A
authors.initials: GA
authors.lastname: Spinas
authors.forename: Roger
authors.initials: R
authors.lastname: Lehmann
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000737:chemistry; D002318:Cardiovascular Diseases / Q000097:blood; D015331:Cohort Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006454:Hemoglobins / Q000737:chemistry*; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000150:complications* / Q000628:therapy; D007165:Immunosuppression Therapy; D007328:Insulin / Q000097:blood / Q000627:therapeutic use*; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D007676:Kidney Failure, Chronic / Q000097:blood; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D001786:Blood Glucose; D006454:Hemoglobins; D007328:Insulin