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The impact of islet mass,number of transplants,and time between transplants on graft function in a national islet transplant program
Authors:Shareen Forbes,Anneliese J. Flatt,Denise Bennett,Robert Crookston,Mirka Pimkova,Linda Birtles,Andrew Pernet,Ruth C. Wood,Keith Burling,Peter Barker,Claire Counter,Alistair Lumb,Pratik Choudhary,Martin   K. Rutter,Miranda Rosenthal,Andrew Sutherland,John Casey,Paul Johnson,James A. M. Shaw
Abstract:
The UK islet allotransplant program is nationally funded to deliver one or two transplants over 12 months to individuals with type 1 diabetes and recurrent severe hypoglycemia. Analyses were undertaken 10 years after program inception to evaluate associations between transplanted mass; single versus two transplants; time between two transplants and graft survival (stimulated C-peptide >50 pmol/L) and function. In total, 84 islet transplant recipients were studied. Uninterrupted graft survival over 12 months was attained in 23 (68%) single and 47 (94%) (p = .002) two transplant recipients (separated by [median (IQR)] 6 (3–8) months). 64% recipients of one or two transplants with uninterrupted function at 12 months sustained graft function at 6 years. Total transplanted mass was associated with Mixed Meal Tolerance Test stimulated C-peptide at 12 months (p < .01). Despite 1.9-fold greater transplanted mass in recipients of two versus one islet infusion (12 218 [9291–15 417] vs. 6442 [5156–7639] IEQ/kg; p < .0001), stimulated C-peptide was not significantly higher. Shorter time between transplants was associated with greater insulin dose reduction at 12 months (beta ?0.35; p = .02). Graft survival over the first 12 months was greater in recipients of two versus one islet transplant in the UK program, although function at 1 and 6 years was comparable. Minimizing the interval between 2 islet infusions may maximize cumulative impact on graft function.
Keywords:clinical research/practice  diabetes: type 1  endocrinology/diabetology  graft survival  islet isolation  islet transplantation
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