Islet transplantation as a treatment for hypoglycemia unawareness syndrome. Evaluation of the pilot program and comparison with pancreas transplantation
Authors:
Martina Zahradnická 1; Peter Girman 1; Jan Kříž 1; Zuzana Berková 2; Tomáš Koblas 2; Ema Vávrová 1; Lucie Kosinová 2; David Habart 2; Eva Fábryová 2; Eva Dovolilová 2; Tomáš Neškudla 1; MUDr. Jan Peregrin 3; Jozef Kováč 3; Květoslav Lipár 4; Matěj Kočík 4; Lenka Németová 1; Jiří Svoboda 5; František Saudek 1
Authors‘ workplace:
Klinika diabetologie, IKEM, Praha
1; Centrum experimentální medicíny IKEM, Praha
2; Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha
3; Klinika transplantační chirurgie, IKEM
4; Oddělení datového centra IKEM, Praha
5
Published in:
Čas. Lék. čes. 2016; 155: 349-356
Category:
Original Article
Overview
Islet transplantation (ITx) started in 2005 in IKEM as a potentially safer alternative to pancreas transplantation (PTx), which so far had represented the method of choice in type-1 diabetic patients with conservatively intractable hypoglycemia unawareness syndrome. The aim of the study was to compare these two methods with regard to severe hypoglycemia elimination and to frequency of complications.
Up to November 2015 a total number of 48 patients underwent ITx. The results from 22 patients with hypoglycemia unawareness were statistically analyzed. The mean number of transplanted islet equivalents was 12,096 (6,933−16,705) IEQ/kg administered percutaneously in local anesthesia under radiological control to the portal vein. 44 patients underwent PTx from 1996. We evaluated glycated hemoglobin(HbA1c), insulin dose, fasting and stimulated C-peptide, frequency of severe hypoglycemia and complications. Medians (interquartile range) were analyzed using the Wilcoxon signed-rank test.
One and two years after ITx, HbA1c decreased, C-peptide became significantly positive, insulin dose and frequency of severe hypoglycemia decreased and 18 % of ITx recipients were temporarily insulin-independent. Bleeding was present in 41 % of patients. One year after PTx, 73 % of patients were insulin and hypoglycemia-free, after two years 68 % of patients were insulin and hypoglycemia-free; graftectomy occurred in 20 % of recipients.
Both methods led to restoration of insulin secretion and severe hypoglycemia elimination. PTx made more recipients insulin-independent at the cost of serious complications.
Keywords:
islet transplantation, pancreas transplantation, complications, hypoglycemia
Sources
1. Choudhary P, Rickels MR, Senior PA et al. Evidence-informed clinical practice recommendations for treatment of type 1 diabetes complicated by problematic hypoglycemia. Diabetes Care. 2015; 38(6): 1016–1029.
2. Saudek F. Transplantace pankreatu a pankreatických ostrůvků v léčbě diabetu. Postgraduální medicína 2012; 14: 11–18.
3. Mindlová M, Saudek F. Autonomní selhání způsobené recidivujícími hypoglykémiemi, jeho klinické hodnocení a terapie. Praktický lékař 2007; 87(1): 52–57.
4. Rickels MR. Recovery of endocrine function after islet and pancreas transplantation. Curr Diab Rep 2012; 12(5): 587–596.
5. Fioretto P, Steffes MW, Sutherland DER et al. Reversal of lesions of diabetic nephropathy after pancreas transplantation. N Engl J Med 1998; 339(2): 69–75.
6. Kennedy WR, Navarro X, Goetz FC et al. Effects of pancreatic transplantation on diabetic neuropathy. N Engl J Med 1990; 322(15): 1031–1037.
7. Lee TC, Barshes NR, O’Mahony CA et al. The effect of pancreatic islet transplantation on progression of diabetic retinopathy and neuropathy. Transplant Proc 2005; 37(5): 2263–2265.
8. Kleinclauss F, Fauda M, Sutherland DE et al. Pancreas after living donor kidney transplants in diabetic patients: impact on long-term kidney graft function. Clin Transplant. 2009; 23(4): 437–446.
9. Barton FB, Rickels MR, Alejandro R et al. Improvement in outcomes of clinical islet transplantation: 1999–2010. Diabetes Care 2012; 35: 1436–1445.
10. Lehmann R, Graziano J, Brockmann J et al. Glycemic control in simultaneous islet-kidney versus pancreas-kidney transplantation in type 1 diabetes: a prospective 13-year follow-up. Diabetes Care 2015; 38(5): 752–759.
11. Saudek F, Girman P, Kříž J et al. Léčba diabetu transplantací izolovaných Langerhansových ostrůvků. Časopis lékařů českých 2011; 150: 49–55.
12. Koh A, Senior P, Salam A et al. Insulin-heparin infusions peritransplant substantially improve single-donor clinical transplant success. Transplantation 2010; 89: 465–471.
13. Clarke WL, Cox DJ, Gonder-Frederick LA et al. Reduced awareness of hypoglycemia in adults with IDDM. A prospective study of hypoglycemic frequency and associated symptoms. Diabetes Care 1995; 18(4): 517–522.
14. Gold AE, MacLeod KM, Frier BM. Frequency of severe hypoglycemia in patients with type I diabetes with impaired awareness of hypoglycemia. Diabetes Care 1994; 17(7): 697–703.
15. Service FJ, Molnar GD, Rosevear JW et al. Mean amplitude of glycemic excursions, a measure of diabetic instability. Diabetes 1970; 19(9): 644–655.
16. Girman P, Saudek F. The IKEM pancreas and islet transplant program as part of healthcare for type 1 diabetes patients: retrospective analysis of outcome from 1983 to 2010. Rev Diabet Stud. 2011; 8(1): 35–43.
17. Tiwari JL, Schneider B, Barton F, Anderson SA. Islet cell transplantation in type 1 diabetes: an analysis of efficacy outcomes and considerations for trial designs. Am J Transplant. 2012; 12(7): 1898–1907.
18. Alejandro R, Barton FB, Hering B, Wease S. The CITR investigators. 2008 update from the collaborative islet transplant registry. Transplantation 2008; 86(12): 1783–1788.
19. Moassesfar S, Masharani U, Frassetto LA et al. A comparative analysis of the safety, efficacy, and cost of islet versus pancreas transplantation in nonuremic patients with type 1 diabetes. Am J Transplant 2016; 16(2): 518–526.
20. Niclauss N, Bosco D, Morel P et al. Influence of donor age on islet isolation and transplantation outcome. Transplantation. 2011; 91(3): 360–366.
21. Niclauss N, Morel P, Berney T. Has the gap between pancreas and islet transplantation closed? Transplantation 2014; 98(6): 593–599.
22. Forbes S, McGowan NW, Duncan K et al. Islet transplantation from a nationally funded UK centre reaches socially deprived groups and improves metabolic outcomes. Diabetologia 2015; 58(6): 1300–1308.
23. Marada T, Lipár K, Adamec M et al. Simultánní transplantace ledviny a Langerhansových ostrůvků. Rozhledy v chirurgii 2011; 90(2): 111–113.
Labels
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain managementArticle was published in
Journal of Czech Physicians
Most read in this issue
- The secular trend in body height and weight in the adult population in the Czech republic
- Correct indications and performing of autopsies in the Czech republic
- Clinical evaluation of acid-base status: Henderson-Hasselbalch, or Stewart-Fencl approach?
- The challenges of diagnostic reasoning or "how doctors think"