期刊
CLINICAL TRANSPLANTATION
卷 26, 期 5, 页码 E471-E484出版社
WILEY-BLACKWELL
DOI: 10.1111/ctr.12011
关键词
adverse event; anti-inflammatory agents; antithymocyte globulin; sirolimus; Type 1 diabetes
资金
- All Saints Health Foundation
- National Institute of Diabetes and Digestive and Kidney Diseases [1R21DK090513-01]
- Juvenile Diabetes Research Foundation [3-2011-447]
Background Islet cell transplantation (ICT) is a promising approach to cure patients with type 1 diabetes. We have implemented a new immunosuppression protocol with antithymoglobulin plus anti-inflammatory agents of anakinra and eternacept for induction and tacrolimus plus mycophenolate mofetil for maintenance [T-cell depletion with anti-inflammatory (TCD-AI) protocol], resulting in successful single-donor ICT. Methods Eight islet recipients with type 1 diabetes reported adverse events (AEs) monthly. AEs were compared between three groups: first infusion with the TCD-AI protocol (TCD-AI-1st) and first and second infusion with the Edmonton-type protocol (Edmonton-1st and Edmonton-2nd). Results The incidence of symptomatic AEs within the initial three months in the TCD-AI-1st group was less than in the Edmonton-1st and Edmonton-2nd groups, with a marginally significant difference (mean +/- SE: 5.5 +/- 0.3, 7.5 +/- 0.5, and 8.3 +/- 1.3, respectively; p = 0.07). A significant reduction in liver enzyme elevation after ICT was found in the TCD-AI-1st group compared with the Edmonton-1st and Edmonton-2nd groups (p < 0.05). Because of AEs, all patients in the Edmonton protocol eventually converted to the TCD-AI protocol, whereas all patients tolerated the TCD-AI protocol. Conclusions TCD-AI protocol can be tolerated for successful ICT, although this study includes small cohort, and large population trial should be taken.
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