title: A Comparative Analysis of the Safety, Efficacy, and Cost of Islet Versus Pancreas Transplantation in Nonuremic Patients With Type 1 Diabetes.
abstract: Few current studies compare the outcomes of islet transplantation alone (ITA) and pancreas transplantation alone (PTA) for type 1 diabetes (T1D). We examined these two beta cell replacement therapies in nonuremic patients with T1D with respect to safety, graft function and cost. Sequential patients received PTA (n = 15) or ITA (n = 10) at our institution. Assessments of graft function included duration of insulin independence; glycemic control, as measured by hemoglobin A1c; and elimination of severe hypoglycemia. Cost analysis included all normalized costs associated with transplantation and inpatient management. ITA patients received one (n = 6) or two (n = 4) islet transplants. Mean duration of insulin independence in this group was 35 mo; 90% were independent at 1 year, and 70% were independent at 3 years. Mean duration of insulin independence in PTA was 55 mo; 93% were insulin independent at 1 year, and 64% were independent at 3 years. Glycemic control was comparable in all patients with functioning grafts, as were overall costs ($138 872 for ITA, $134 748 for PTA). We conclude that with advances in islet isolation and posttransplant management, ITA can produce outcomes similar to PTA and represents a clinically viable option to achieve long-term insulin independence in selected patients with T1D.
authors.affiliation: Pediatrics, University of California, San Francisco, San Francisco, CA.
authors.forename: S
authors.initials: S
authors.lastname: Moassesfar
authors.affiliation: Medicine, University of California, San Francisco, San Francisco, CA.
authors.forename: U
authors.initials: U
authors.lastname: Masharani
authors.affiliation: Medicine, University of California, San Francisco, San Francisco, CA.
authors.forename: L A
authors.initials: LA
authors.lastname: Frassetto
authors.affiliation: Transplant Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: G L
authors.initials: GL
authors.lastname: Szot
authors.affiliation: Transplant Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: M
authors.initials: M
authors.lastname: Tavakol
authors.affiliation: Transplant Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: P G
authors.initials: PG
authors.lastname: Stock
authors.affiliation: Transplant Surgery, University of California, San Francisco, San Francisco, CA.
authors.forename: A M
authors.initials: AM
authors.lastname: Posselt
mesh_terms: D000328:Adult; D003362:Cost-Benefit Analysis; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016381:Islets of Langerhans Transplantation / Q000191:economics*; D007677:Kidney Function Tests; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000191:economics*; D011379:Prognosis; D012307:Risk Factors; D012449:Safety
keywords: C-peptide; clinical research; insulin; islet isolation; islet transplantation; islets of Langerhans; pancreas; practice; simultaneous pancreas-kidney; type 1