Bootcongres

Background: Islet transplantation is performed in a select group of patients with type 1 diabetes mellitus that are often characterised by instable glycemic control and progressive complications. Immunosuppressive regimens play an important role in long-term islet function. We aimed to investigate the efficacy and effect on renal function of islet transplantation in patients with type 1 diabetes and a previous kidney transplantation using an alemtuzumab-based induction regimen. 

Methods: Patients with type 1 diabetes, who had received kidney transplantation > 6 months previously, received T-cell depletion with 30 mg alemtuzumab as induction therapy for their first islet transplantation and basiliximab induction therapy for subsequent islet transplantations. Maintenance immunesuppression consisted of triple immunosuppression (a calcineurin inhibitor, mycophenolate mofetil and prednisolone). A GLP-1 receptor agonist and antibiotic prophylaxis was administered post-transplantation. At 3 and 12 months after the last islet transplantation a mixed meal test to evaluate islet function was performed and renal function was assessed. 

Results: 13 patients (8M/5F, age 50.9.± 9.2 years, BMI 23.2±2 kg/m², duration of diabetes 35±9 years, duration since (last) kidney transplantation 8.7±7 years) received a total of 22 pancreatic islet transplantations (1.7±0.6 per patient). After 1 year 7/13 patients (54%) were free from insulin therapy. HbA1c dropped from 57.2±13.1 to 43.4±8.7 mmol/mol (p=0.003) and patients were free from severe hypoglycaemia. Stimulated C-peptide increased from a baseline of <0.05 nmol/l before islet transplantation to a maximum of 1.82±0.82 nmol/l (p<0.001) after islet transplantation. Mean creatinin clearance (using eGFR) was 43.5±12.2 at baseline and 44.9±10.3 ml/min/1,73m² one year after islet transplantation (p=0.37). Complications included bleeding from the liver after two transplantation procedures that required blood transfusion. After initiating the use of foam plugs in the catheter tract no more bleeding episodes were observed. Partial portal vein thrombosis was observed in one patient that resolved after LMW-heparin.

Conclusion: Islet after-kidney-transplantation in patients with type 1 diabetes is a relatively safe procedure that leads to considerable improvement in glycemic control, in particular hypoglycemic episodes. No adverse effect on renal function was observed.