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Long‐Term Immunosuppression After Solitary Islet Transplantation Is Associated With Preserved C‐Peptide Secretion for More Than a Decade
Author(s) -
Blau J. E.,
Abegg M. R.,
Flegel W. A.,
Zhao X.,
Harlan D. M.,
Rother K. I.
Publication year - 2015
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.13383
Subject(s) - immunosuppression , medicine , daclizumab , islet , insulin , transplantation , hypoglycemia , c peptide , type 1 diabetes , diabetes mellitus , tacrolimus , endocrinology , gastroenterology
We report on two patients with type 1 diabetes (T1D) after solitary islet transplantation in 2001. They received steroid‐sparing immunosuppression (daclizumab, sirolimus, and tacrolimus according to the Edmonton protocol). Both patients became insulin independent for 2 years: Patient A, a 42‐year‐old female with a 12‐year history of T1D, received two islet infusions; patient B, a 53‐year‐old female with a 40‐year T1D history, received one islet infusion. Pretransplant, both had undetectable C‐peptide concentrations and frequent and severe hypoglycemia. Pretransplant, hemoglobin A1c (HbA1c) was 7.8% and 8.8% and insulin requirements were 0.47 and 0.33 units/kg/day, respectively. Posttransplant, C‐peptide levels remained detectable while immunosuppression was continued, but decreased over time. Insulin was re‐started 2 years posttransplant in both patients. Since patient A's glycemia and insulin requirements trended toward pretransplant levels, immunosuppression was discontinued after 13 years. This resulted in a sudden cessation of C‐peptide secretion. Patient B continues on immunosuppression, has better HbA1c, and half the insulin requirement compared to pretransplant. Both patients no longer experience severe hypoglycemia. Herein, we document blood glucose concentrations over time (>30 000 measurements per patient) and β cell function based on C‐peptide secretion. Despite renewed insulin dependence, both patients express satisfaction with having undergone the procedure.