Aims/hypothesis: Islet transplantation is a minimally invasive approach to curing Type I (insulin-dependent) diabetes mellitus. Success has recently been reported in patients receiving solitary islet transplants but the outcome in patients receiving islets together with, or after, kidney transplants has been limited and unpredictable.
Methods: Here we report successful islet transplantation in a cohort of 15 patients with Type I diabetes who were followed for at least 1 year after islet transplantation, after having already received kidney allografts because of end-stage nephropathy.
Results: C-peptide after transplantation was higher than 0.17 nmol/l in all 15 recipients, reflecting the absence of primary non-function. Insulin requirement was reduced by over 50 % in all but one patient, and insulin independence was achieved in 10 (66 %) recipients, five of whom now have stable, prolonged insulin independence, well controlled fasting glycaemia, a substantial first-phase and normal second-phase response to glucose, normal insulin sensitivity (HOMA analyses) and HbA1 c of under 6.2 % (33, 26, 18, 13 and 12 months after transplantation respectively). Of importance for patient management, an assessment of fasting blood glucose and proinsulin values following overnight withdrawal of insulin administration one month after transplantation was a potent predictor of insulin independence, and could be used to decide patients who should have further islet preparations.
Conclusion/interpretation: These findings support the use of islet transplantation as a cure for Type I diabetes in patients with severe complications.
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Article Synopsis
- Islet transplantation (IT) is a promising therapy primarily benefiting individuals with severe type 1 diabetes and healthcare professionals working on its delivery.
- Recent data indicates that IT may provide survival benefits, especially when combined with renal transplantation.
- Further multi-center studies with long-term follow-ups are suggested to validate the survival advantages of IT compared to those who qualify but do not receive the procedure.
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