Journal
TRANSPLANTATION
Volume 86, Issue 12, Pages 1762-1766Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/TP.0b013e318190b052
Keywords
Islet cell transplantation; Diabetic microvascular complications
Categories
Funding
- Juvenile Diabetes Research Foundation
- Vancouver Coastal Health Research Institute
- BC Transplant Society
- Ike Barber Research Endowment
- Michael Smith Foundation for Health Research
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Background. We hypothesized that transplantation Of islets into type I diabetics could improve outcomes of glucose metabolism, renal function, retinopathy, and neuropathy compared with intensive medical therapy. Methods. We conducted a prospective, crossover, cohort study of intensive medical therapy (group 1) versus islet cell transplantation (group 2) in 42 patients. All were enrolled in group I then 31 crossed over with group 2 when islet donation became available. Transplantation was performed by portal venous embolization of more than 12,000 islet equivalents/kg body weight under cover of immunosuppression with antithymocyte globulin, tacrolimus, and mycophenolate. Outcome measures were HbA1c, change in glomerular filtration rate (GFR), progression of retinopathy, and change in nerve conduction velocity. This report details interim analysis of outcomes after 34 18 months (group 1) and 38 +/- 18 months (group 2). Results. HbA1c (%) in group 1 was 7.5 +/- 0.9 versus 6.6 +/- 0.7 in group 2 (P<0.01). GFR (mL/min/month) declined in both groups (group 1 -0.45 +/- 0.7 vs. group 2 -0.12 +/- 0.7, P=0.1). Slope of the GFR decline in group 1 was significantly more than 0. Retinopathy progressed in 10 of 82 eyes in group 1 versus 0 of 51 in group 2 (P<0.01). Nerve conduction velocity (m/sec) remained stable in group 1 (47.8 +/- 5 to 47.1 +/- 5 m/sec) and group 2 (47.2 +/- 4.5 to 47.7 +/- 3.5). Conclusion. Islet transplantation yields improved HbA1c and less progression of retinopathy compared with intensive medical therapy during 3 years follow-up.
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