Islet autotransplant outcomes after total pancreatectomy: a contrast to islet allograft outcomes

DER Sutherland, AC Gruessner, AM Carlson… - …, 2008 - journals.lww.com
DER Sutherland, AC Gruessner, AM Carlson, JJ Blondet, AN Balamurugan, KF Reigstad…
Transplantation, 2008journals.lww.com
Methods. IAT function was determined in 173 patients after total pancreatectomy at our
center. Islet function was considered full in insulin-independent patients, partial when
euglycemic on once-daily long-acting insulin (all tested were C-peptide positive), and failed
if on a standard diabetic regimen. Outcomes for autoislet recipients by Kaplan-Meier survival
analysis were compared with those of alloislet recipients in the Collaborative Islet Transplant
Registry. Results. IAT function (full/partial combined) and insulin independence correlated …
Methods.
IAT function was determined in 173 patients after total pancreatectomy at our center. Islet function was considered full in insulin-independent patients, partial when euglycemic on once-daily long-acting insulin (all tested were C-peptide positive), and failed if on a standard diabetic regimen. Outcomes for autoislet recipients by Kaplan-Meier survival analysis were compared with those of alloislet recipients in the Collaborative Islet Transplant Registry.
Results.
IAT function (full/partial combined) and insulin independence correlated with islet yield. Overall only 65% functioned within the first year, and only 32% were insulin independent, but of IATs that functioned initially (n= 112), 85% remained so 2-years later, in contrast to 66% of allografts (n= 262). Of IAT recipients who became insulin independent (n= 55), 74% remained so 2-years later versus 45% of initially insulin-independent allograft recipients (n= 154). Of IATs that functioned or induced insulin independence, the rates at 5 years were 69% and 47%, respectively.
Conclusion.
Islet function is more resilient in autografts than allografts. Indeed, the 5-year insulin-independence persistence rate for IATs is similar to the 2-year rate for allografts. Several factors unique to allocases are likely responsible for the differences, including donor brain death, longer cold ischemia time, diabetogenic immunosuppression, and auto-and alloimmunity. IAT outcomes provide a minimum theoretical standard to work toward in allotransplantation.
Lippincott Williams & Wilkins