Ten-Year Outcome of Islet Alone or Islet After Kidney Transplantation in Type 1 Diabetes: A Prospective Parallel-Arm Cohort Study
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- Marie-Christine Vantyghem
- University of Lille, U1190-EGID, Lille, France
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- Mikael Chetboun
- University of Lille, U1190-EGID, Lille, France
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- Valéry Gmyr
- University of Lille, U1190-EGID, Lille, France
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- Arnaud Jannin
- Department of Endocrinology, Diabetology, and Metabolism, Centre Hospitalier Universitaire de Lille, Lille, France
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- Stéphanie Espiard
- Department of Endocrinology, Diabetology, and Metabolism, Centre Hospitalier Universitaire de Lille, Lille, France
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- Kristell Le Mapihan
- Department of Endocrinology, Diabetology, and Metabolism, Centre Hospitalier Universitaire de Lille, Lille, France
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- Violeta Raverdy
- University of Lille, U1190-EGID, Lille, France
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- Nathalie Delalleau
- University of Lille, U1190-EGID, Lille, France
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- François Machuron
- Department of Methodology, Biostatistics, and Data Management, Centre Hospitalier Universitaire de Lille, Lille, France
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- Thomas Hubert
- University of Lille, U1190-EGID, Lille, France
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- Marie Frimat
- Department of Nephrology, Centre Hospitalier Universitaire de Lille, Lille, France
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- Eric Van Belle
- Department of Cardiology, Centre Hospitalier Universitaire de Lille, Lille, France
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- Marc Hazzan
- Department of Nephrology, Centre Hospitalier Universitaire de Lille, Lille, France
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- Pascal Pigny
- Department of Biochemistry and Hormonology, Centre Hospitalier Universitaire de Lille, Lille, France
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- Christian Noel
- Department of Nephrology, Centre Hospitalier Universitaire de Lille, Lille, France
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- Robert Caiazzo
- University of Lille, U1190-EGID, Lille, France
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- Julie Kerr-Conte
- University of Lille, U1190-EGID, Lille, France
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- François Pattou
- University of Lille, U1190-EGID, Lille, France
説明
<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>The long-term outcome of allogenic islet transplantation is unknown. The aim of this study was to evaluate the 10-year outcome of islet transplantation in patients with type 1 diabetes and hypoglycemia unawareness and/or a functioning kidney graft.</jats:p> </jats:sec> <jats:sec> <jats:title>RESEARCH DESIGN AND METHODS</jats:title> <jats:p>We enrolled in this prospective parallel-arm cohort study 28 subjects with type 1 diabetes who received islet transplantation either alone (ITA) or after a kidney graft (IAK). Islet transplantation consisted of two or three intraportal infusions of allogenic islets administered within (median [interquartile range]) 68 days (43–92). Immunosuppression was induced with interleukin-2 receptor antibodies and maintained with sirolimus and tacrolimus. The primary outcome was insulin independence with A1C ≤6.5% (48 mmol/mol). Secondary outcomes were patient and graft survival, severe hypoglycemic events (SHEs), metabolic control, and renal function.</jats:p> </jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>The primary outcome was met by (Kaplan-Meier estimates [95% CI]) 39% (22–57) and 28% (13–45) of patients 5 and 10 years after islet transplantation, respectively. Graft function persisted in 82% (62–92) and 78% (57–89) of case subjects after 5 and 10 years, respectively, and was associated with improved glucose control, reduced need for exogenous insulin, and a marked decrease of SHEs. ITA and IAK had similar outcomes. Primary graft function, evaluated 1 month after the last islet infusion, was significantly associated with the duration of graft function and insulin independence.</jats:p> </jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Islet transplantation with the Edmonton protocol can provide 10-year markedly improved metabolic control without SHEs in three-quarters of patients with type 1 diabetes, kidney transplanted or not.</jats:p> </jats:sec>
収録刊行物
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- Diabetes Care
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Diabetes Care 42 (11), 2042-2049, 2019-10-10
American Diabetes Association