Attainment of metabolic goals in the integrated UK islet transplant program with locally isolated and transported preparations
A M Brooks, N Walker, A Aldibbiat, S Hughes, G Jones, J de Havilland, P Choudhary, G C Huang, N Parrott, N W A McGowan, J Casey, L Mumford, P Barker, K Burling, R Hovorka, M Walker, R M Smith, S Forbes, M K Rutter, S Amiel, M J Rosenthal, P Johnson, J A M Shaw, A M Brooks, N Walker, A Aldibbiat, S Hughes, G Jones, J de Havilland, P Choudhary, G C Huang, N Parrott, N W A McGowan, J Casey, L Mumford, P Barker, K Burling, R Hovorka, M Walker, R M Smith, S Forbes, M K Rutter, S Amiel, M J Rosenthal, P Johnson, J A M Shaw
Abstract
The objective was to determine whether metabolic goals have been achieved with locally isolated and transported preparations over the first 3 years of the UK's nationally funded integrated islet transplant program. Twenty islet recipients with C-peptide negative type 1 diabetes and recurrent severe hypoglycemia consented to the study, including standardized meal tolerance tests. Participants received a total of 35 infusions (seven recipients: single graft; 11 recipients: two grafts: two recipients: three grafts). Graft function was maintained in 80% at [median (interquartile range)] 24 (13.5-36) months postfirst transplant. Severe hypoglycemia was reduced from 20 (7-50) episodes/patient-year pretransplant to 0.3 (0-1.6) episodes/patient-year posttransplant (p < 0.001). Resolution of impaired hypoglycemia awareness was confirmed [pretransplant: Gold score 6 (5-7); 24 (13.5-36) months: 3 (1.5-4.5); p < 0.03]. Target HbA1c of <7.0% was attained/maintained in 70% of recipients [pretransplant: 8.0 (7.0-9.6)%; 24 (13.5-36) months: 6.2 (5.7-8.4)%; p < 0.001], with 60% reduction in insulin dose [pretransplant: 0.51 (0.41-0.62) units/kg; 24 (13.5-36) months: 0.20 (0-0.37) units/kg; p < 0.001]. Metabolic outcomes were comparable 12 months posttransplant in those receiving transported versus only locally isolated islets [12 month stimulated C-peptide: transported 788 (114-1764) pmol/L (n = 9); locally isolated 407 (126-830) pmol/L (n = 11); p = 0.32]. Metabolic goals have been attained within the equitably available, fully integrated UK islet transplant program with both transported and locally isolated preparations.
Keywords: Islet transplantation; islet transport; meal tolerance test; severe hypoglycemia.
© Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.
Source: PubMed