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Islet alloautotransplantation: Allogeneic pancreas transplantation followed by transplant pancreatectomy and islet transplantation
Author(s) -
Nijhoff M. F.,
Dubbeld J.,
Erkel A. R.,
Boog P. J. M.,
Rabelink T. J.,
Engelse M. A.,
Koning E.J.P.
Publication year - 2018
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.14593
Subject(s) - medicine , transplantation , pancreas , islet , pancreas transplantation , type 1 diabetes , surgery , pancreatectomy , islet cell transplantation , diabetes mellitus , glycated hemoglobin , anastomosis , end stage renal disease , urology , gastroenterology , kidney transplantation , insulin , hemodialysis , type 2 diabetes , endocrinology
Simultaneous pancreas–kidney ( SPK ) transplantation is an important treatment option for patients with type 1 diabetes (T1D) and end‐stage renal disease ( ESRD ). Due to complications, in up to 10% of patients, allograft pancreatectomy is necessary shortly after transplantation. Usually the donor pancreas is discarded. Here, we report on a novel procedure to rescue endocrine tissue after allograft pancreatectomy. A 39‐year‐old woman with T1D and ESRD who had undergone SPK transplantation required emergency allograft pancreatectomy due to bleeding at the vascular anastomosis. Islets were isolated from the removed pancreas allograft, and almost 480 000 islet equivalents were infused into the portal vein. The patient recovered fully. After 3 months, near‐normal mixed meal test (fasting glucose 7.0 mmol/L, 2‐hour glucose 7.5 mmol/L, maximal stimulated C‐peptide 3.25 nmol/L, without insulin use in the preceding 36 hours) was achieved. Glycated hemoglobin while taking a low dose of long‐acting insulin was 32.7 mmol/mol hemoglobin (5.3%). When a donor pancreas is lost after transplantation, rescue β cell therapy by islet alloautotransplantation enables optimal use of scarce donor pancreata to optimize glycemic control without additional HLA alloantigen exposure.