A Comparative Analysis of the Safety,Efficacy, and Cost of Islet Versus Pancreas Transplantation in Nonuremic Patients With Type 1 Diabetes |
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| Authors: | S. Moassesfar U. Masharani L. A. Frassetto G. L. Szot M. Tavakol P. G. Stock A. M. Posselt |
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| Affiliation: | 1. Pediatrics, University of California, San Francisco, San Francisco, CA;2. Medicine, University of California, San Francisco, San Francisco, CA;3. Transplant Surgery, University of California, San Francisco, San Francisco, CA |
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| Abstract: | Few current studies compare the outcomes of islet transplantation alone (ITA) and pancreas transplantation alone (PTA) for type 1 diabetes (T1D). We examined these two beta cell replacement therapies in nonuremic patients with T1D with respect to safety, graft function and cost. Sequential patients received PTA (n = 15) or ITA (n = 10) at our institution. Assessments of graft function included duration of insulin independence; glycemic control, as measured by hemoglobin A1c; and elimination of severe hypoglycemia. Cost analysis included all normalized costs associated with transplantation and inpatient management. ITA patients received one (n = 6) or two (n = 4) islet transplants. Mean duration of insulin independence in this group was 35 mo; 90% were independent at 1 year, and 70% were independent at 3 years. Mean duration of insulin independence in PTA was 55 mo; 93% were insulin independent at 1 year, and 64% were independent at 3 years. Glycemic control was comparable in all patients with functioning grafts, as were overall costs ($138 872 for ITA, $134 748 for PTA). We conclude that with advances in islet isolation and posttransplant management, ITA can produce outcomes similar to PTA and represents a clinically viable option to achieve long‐term insulin independence in selected patients with T1D. |
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| Keywords: | clinical research practice islet transplantation pancreas simultaneous pancreas‐kidney type 1 islet isolation insulin C‐peptide islets of Langerhans |
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