title: [Islet transplantation as a treatment for hypoglycemia unawareness syndrome. Evaluation of the pilot program and comparison with pancreas transplantation].
abstract: Islet transplantation (ITx) started in 2005 in IKEM as a potentially safer alternative to pancreas transplantation (PTx), which so far had represented the method of choice in type-1 diabetic patients with conservatively intractable hypoglycemia unawareness syndrome. The aim of the study was to compare these two methods with regard to severe hypoglycemia elimination and to frequency of complications.Up to November 2015 a total number of 48 patients underwent ITx. The results from 22 patients with hypoglycemia unawareness were statistically analyzed. The mean number of transplanted islet equivalents was 12,096 (6,93316,705) IEQ/kg administered percutaneously in local anesthesia under radiological control to the portal vein. 44 patients underwent PTx from 1996. We evaluated glycated hemoglobin(HbA1c), insulin dose, fasting and stimulated C-peptide, frequency of severe hypoglycemia and complications. Medians (interquartile range) were analyzed using the Wilcoxon signed-rank test.One and two years after ITx, HbA1c decreased, C-peptide became significantly positive, insulin dose and frequency of severe hypoglycemia decreased and 18 % of ITx recipients were temporarily insulin-independent. Bleeding was present in 41 % of patients. One year after PTx, 73 % of patients were insulin and hypoglycemia-free, after two years 68 % of patients were insulin and hypoglycemia-free; graftectomy occurred in 20 % of recipients.Both methods led to restoration of insulin secretion and severe hypoglycemia elimination. PTx made more recipients insulin-independent at the cost of serious complications.
authors.forename: Martina
authors.initials: M
authors.lastname: Zahradnická
authors.forename: Peter
authors.initials: P
authors.lastname: Girman
authors.forename: Jan
authors.initials: J
authors.lastname: Kříž
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Berková
authors.forename: Tomáš
authors.initials: T
authors.lastname: Koblas
authors.forename: Ema
authors.initials: E
authors.lastname: Vávrová
authors.forename: Lucie
authors.initials: L
authors.lastname: Kosinová
authors.forename: David
authors.initials: D
authors.lastname: Habart
authors.forename: Eva
authors.initials: E
authors.lastname: Fábryová
authors.forename: Eva
authors.initials: E
authors.lastname: Dovolilová
authors.forename: Tomáš
authors.initials: T
authors.lastname: Neškudla
authors.forename: Jan
authors.initials: J
authors.lastname: Peregrin
authors.forename: Jozef
authors.initials: J
authors.lastname: Kováč
authors.forename: Květoslav
authors.initials: K
authors.lastname: Lipár
authors.forename: Matěj
authors.initials: M
authors.lastname: Kočík
authors.forename: Lenka
authors.initials: L
authors.lastname: Németová
authors.forename: Jiří
authors.initials: J
authors.lastname: Svoboda
authors.forename: František
authors.initials: F
authors.lastname: Saudek
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007003:Hypoglycemia / Q000453:epidemiology / Q000601:surgery*; D016381:Islets of Langerhans Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods* / Q000706:statistics & numerical data; D010865:Pilot Projects; D011183:Postoperative Complications / Q000453:epidemiology; D013577:Syndrome; D016896:Treatment Outcome
keywords: complications hypoglycemia.; islet transplantation; pancreas transplantation