期刊
AMERICAN JOURNAL OF TRANSPLANTATION
卷 13, 期 12, 页码 3236-3243出版社
WILEY
DOI: 10.1111/ajt.12469
关键词
Islet transplantation; islet transport; meal tolerance test; severe hypoglycemia
资金
- NHS National Commissioning Group
- Diabetes UK [BDA 06/0003362]
- Diabetes Research and Wellness Foundation
- Diabetes Foundation
- Juvenile Diabetes Research Foundation
- Diabetes UK [06/0003362] Funding Source: researchfish
- Medical Research Council [MR/J006742/1] Funding Source: researchfish
- National Institute for Health Research [ACF-2011-01-003] Funding Source: researchfish
The objective was to determine whether metabolic goals have been achieved with locally isolated and transported preparations over the first 3 years of the UK's nationally funded integrated islet transplant program. Twenty islet recipients with C-peptide negative type 1 diabetes and recurrent severe hypoglycemia consented to the study, including standardized meal tolerance tests. Participants received a total of 35 infusions (seven recipients: single graft; 11 recipients: two grafts: two recipients: three grafts). Graft function was maintained in 80% at [median (interquartile range)] 24 (13.5-36) months postfirst transplant. Severe hypoglycemia was reduced from 20 (7-50) episodes/patient-year pretransplant to 0.3 (0-1.6) episodes/patient-year posttransplant (p<0.001). Resolution of impaired hypoglycemia awareness was confirmed [pretransplant: Gold score 6 (5-7); 24 (13.5-36) months: 3 (1.5-4.5); p<0.03]. Target HbA(1c) of <7.0% was attained/maintained in 70% of recipients [pretransplant: 8.0 (7.0-9.6)%; 24 (13.5-36) months: 6.2 (5.7-8.4)%; p<0.001], with 60% reduction in insulin dose [pretransplant: 0.51 (0.41-0.62) units/kg; 24 (13.5-36) months: 0.20 (0-0.37) units/kg; p<0.001]. Metabolic outcomes were comparable 12 months posttransplant in those receiving transported versus only locally isolated islets [12 month stimulated C-peptide: transported 788 (114-1764) pmol/L (n=9); locally isolated 407 (126-830) pmol/L (n=11); p=0.32]. Metabolic goals have been attained within the equitably available, fully integrated UK islet transplant program with both transported and locally isolated preparations. In this report on a cohort of recipients within the UK government-funded fully integrated islet transplant program, the authors demonstrate attainment of metabolic goals with both locally isolated and transported islets with comparable graft survival up to 36 months posttransplant.
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