Experience with a novel efalizumab-based immunosuppressive regimen to facilitate single donor islet cell transplantation

N A Turgeon, J G Avila, J A Cano, J J Hutchinson, I R Badell, A J Page, A B Adams, M H Sears, P H Bowen, A D Kirk, T C Pearson, C P Larsen, N A Turgeon, J G Avila, J A Cano, J J Hutchinson, I R Badell, A J Page, A B Adams, M H Sears, P H Bowen, A D Kirk, T C Pearson, C P Larsen

Abstract

Islet transplantation is an experimental therapy for selected patients with type 1 diabetes (T1DM). It remains limited by immunosuppressive drug toxicity, progressive loss of insulin independence, allosensitization and the need for multiple islet donors. We describe our experience with an efalizumab-based immunosuppressive regimen as compared to the prevailing standard regimen, the Edmonton protocol. Twelve patients with T1DM received islet transplants: eight were treated with the Edmonton protocol; four were treated with daclizumab induction, a 6-month course of tacrolimus, and maintenance with efalizumab and mycophenolate mofetil. The primary endpoint was insulin independence after one islet infusion. Only two Edmonton protocol treated patients achieved the primary endpoint; six required islets from multiple donors, and all experienced leukopenia, mouth ulcers, anemia, diarrhea and hypertransaminasemia. Four became allosensitized. All patients treated with the efalizumab-based regimen achieved insulin independence with normal hemoglobin A1c after a single islet cell infusion and remained insulin independent while on efalizumab. These patients experienced significantly fewer side effects and none became allosensitized. Trial continuation was terminated by withdrawal of efalizumab from the market. These data suggest that this efalizumab-based regimen prevents islet rejection, is well tolerated, and allows for single donor islet transplantation.

© 2010 The Authors Journal compilation © 2010 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1
Figure 1
Stimulated c-peptide (blue), fasting c-peptide (red), and HbA1c (green) in all patients treated in this study.
Figure 2
Figure 2
Insulin levels in all patients treated in this study. Arrows indicate times at which Group 2 patients were discontinued from efalizumab and converted to abatacept (patients 2–4) or voluntarily withdrew from immunosuppression (Subject 1).
Figure 3
Figure 3
Serum creatinine levels and calculated GFR using MDRD calculation in all patients treated in this study.

Source: PubMed

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