Islet transplantation in type 1 diabetes mellitus: single center follow-up on 10 patients
Transplantation of pancreatic islets has evolved into an established therapy for patients with advanced forms of type 1 diabetes with unstable metabolic control and recurrent hypoglyceamia. We report on our single center experience with single islet transplantation in 10 patients.
Methods: All patients were recruited from the own outpatient clinic assuring optimal diabetes management with long-term CSII prior to enrolment. The indication was brittle diabetes and repeated severe hypoglycaemia. The mean HbA1c was 7,9 ± 0,9%. The mean age was 47,3 ± 10,4yrs, BMI ranged at 25,7 ± 2,6 kg/m2. Pre-transplant insulin requirement was 40 ± 15,6 units per day. All patients were subjected to a modified hypoglycemic clamp test before transplantation and during follow-up for determination of hypoglycemic counterregulation. The mean follow-up was 28 months.
Results: All patients were treated by single islet infusion with a mean islet mass of 10.200 ± 4.700 IEQ/kg body weight. Graft function as measured by positive c-peptide was primarily achieved and persistent in all patients. Stimulated c-peptide was 2,4 ± 0,5 nmol/l. The HbA1c was reduced to 6,1 ± 0,6% in the absence of hypoglycemia. Lability-Score was significantly reduced in all 10 islet recipients upon transplantation. Exogenous insulin therapy was withdrawn or adjusted based upon glycemic control and added supportively to avoid metabolic stress. No severe adverse events were documented. During modified hypoglycemic clamp test 7 out of 10 patients showed reconstitution of glucagon response and adrenergic counterregulation.
Conclusion: The reconstitution of endogenous insulin secretion achieved by single islet transplantation combined with supportive insulin therapy was sufficient for maintaining near-normal glycemic control and avoidance of hypoglyceamia. These results strengthen the perception of islet transplantation at our institution as an excellent therapy for selected patients where the primary goal is not insulin independence, but stable glycemic control and avoidance of severe hypoglycemia.