Islet Autotransplant Outcomes After Total Pancreatectomy : A Contrast to Islet Allograft Outcomes

• Published in: Transplantation Vol. 86; no. 12; pp. 1799 - 1802
• Main Authors: SUTHERLAND, David E. R, GRUESSNER, Angelika C, CARLSON, Annelisa M, BLONDET, Juan J, BALAMURUGAN, A. N, REIGSTAD, Katie F, BEILMAN, Gregory J, BERLIN, Melena D, HERING, Bernhard J
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 27-12-2008
• Subjects: Adult; Biological and medical sciences; Diabetes Mellitus, Type 1 - drug therapy; Diabetes Mellitus, Type 1 - epidemiology; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Insulin - metabolism; Insulin - therapeutic use; Insulin Secretion; Islets of Langerhans Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Medical sciences; Pancreatectomy - methods; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Tissue, organ and graft immunology; Transplantation, Autologous - physiology; Transplantation, Homologous - physiology; Treatment Outcome; Prognosis; Langerhans islet; Pancreatectomy; Homograft; Transplantation; Contrast; Autotransplantation; Treatment; Surgery; Total; Evolution; Graft; Endocrine pancreas
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/tp.0b013e31819143ec

Islet allografts are currently associated with a high rate of early insulin independence, but after 1 year insulin-independence rates rapidly decline for unclear reasons. In contrast, as shown here, islet autotransplants (IATs) show durable function and extended insulin-independence rates, despite a lower beta-cell mass.
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.
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.
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.