Prolonged insulin independence after islet allotransplants in recipients with type 1 diabetes

M. D. Bellin, R. Kandaswamy, J. Parkey, H. J. Zhang, B. Liu, S. H. Ihm, J. D. Ansite, J. Witson, P. Bansal-Pakala, A. N. Balamurugan, Klearchos K Papas, D. E R Sutherland, A. Moran, B. J. Hering

Research output: Contribution to journalArticle

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Abstract

We sought to determine the long-term outcomes in type 1 diabetic recipients of intraportal alloislet transplants on a modified immunosuppressive protocol. Six recipients with hypoglycemia unawareness received one to two islet infusions. Induction therapy was with antithymocyte globulin (ATG) plus etanercept for tumor necrosis factor-α blockade. Recipients received cyclosporine and everolimus for maintenance immunosuppression for the first year posttransplant, with mycophenolic acid or mycophenolate mofetil subsequently substituted for everolimus. Recipients have been followed for 1173 ± 270 days since their last infusion for islet graft function (insulin independence, hemoglobin A1c levels and C-peptide production) and for adverse events associated with the study protocol. Of the six recipients, five were insulin-independent at 1 year, and four continue to be insulin-independent at a mean of 3.4 ± 0.4 years posttransplant. None of the six recipients experienced recurrence of severe hypoglycemia. Measured glomerular filtration rate decreased from 110.5 ± 21.2 mL/min/1.73 m2 pretransplant to 82.6 ±19.1 mL/min/1.73 m2 at 1 year posttransplant. In conclusion, islet transplants restored insulin independence for a mean of >3 years in four of six recipients treated with ATG and etanercept induction therapy and with cyclosporine and, initially, everolimus for maintenance. Our results suggest this immunosuppressive protocol may allow long-term graft survival.

Original languageEnglish (US)
Pages (from-to)2463-2470
Number of pages8
JournalAmerican Journal of Transplantation
Volume8
Issue number11
DOIs
StatePublished - Nov 2008
Externally publishedYes

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Type 1 Diabetes Mellitus
Insulin
Mycophenolic Acid
Antilymphocyte Serum
Immunosuppressive Agents
Transplants
Hypoglycemia
Cyclosporine
Maintenance
C-Peptide
Graft Survival
Glomerular Filtration Rate
Immunosuppression
Hemoglobins
Tumor Necrosis Factor-alpha
Recurrence
Therapeutics
Everolimus
Etanercept

Keywords

  • Allograft survival
  • Everolimus
  • Islet graft
  • Islet transplantation
  • Islets
  • Thymoglobulin

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

Cite this

Bellin, M. D., Kandaswamy, R., Parkey, J., Zhang, H. J., Liu, B., Ihm, S. H., ... Hering, B. J. (2008). Prolonged insulin independence after islet allotransplants in recipients with type 1 diabetes. American Journal of Transplantation, 8(11), 2463-2470. https://doi.org/10.1111/j.1600-6143.2008.02404.x

Prolonged insulin independence after islet allotransplants in recipients with type 1 diabetes. / Bellin, M. D.; Kandaswamy, R.; Parkey, J.; Zhang, H. J.; Liu, B.; Ihm, S. H.; Ansite, J. D.; Witson, J.; Bansal-Pakala, P.; Balamurugan, A. N.; Papas, Klearchos K; Sutherland, D. E R; Moran, A.; Hering, B. J.

In: American Journal of Transplantation, Vol. 8, No. 11, 11.2008, p. 2463-2470.

Research output: Contribution to journalArticle

Bellin, MD, Kandaswamy, R, Parkey, J, Zhang, HJ, Liu, B, Ihm, SH, Ansite, JD, Witson, J, Bansal-Pakala, P, Balamurugan, AN, Papas, KK, Sutherland, DER, Moran, A & Hering, BJ 2008, 'Prolonged insulin independence after islet allotransplants in recipients with type 1 diabetes', American Journal of Transplantation, vol. 8, no. 11, pp. 2463-2470. https://doi.org/10.1111/j.1600-6143.2008.02404.x
Bellin, M. D. ; Kandaswamy, R. ; Parkey, J. ; Zhang, H. J. ; Liu, B. ; Ihm, S. H. ; Ansite, J. D. ; Witson, J. ; Bansal-Pakala, P. ; Balamurugan, A. N. ; Papas, Klearchos K ; Sutherland, D. E R ; Moran, A. ; Hering, B. J. / Prolonged insulin independence after islet allotransplants in recipients with type 1 diabetes. In: American Journal of Transplantation. 2008 ; Vol. 8, No. 11. pp. 2463-2470.
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AU - Liu, B.

AU - Ihm, S. H.

AU - Ansite, J. D.

AU - Witson, J.

AU - Bansal-Pakala, P.

AU - Balamurugan, A. N.

AU - Papas, Klearchos K

AU - Sutherland, D. E R

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AU - Hering, B. J.

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