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Ten-year outcomes of islet transplantation in patients with type 1 diabetes: Data from the Swiss-French GRAGIL network |
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| Authors: | Sandrine Lablanche Sophie Borot Anne Wojtusciszyn Kristina Skaare Alfred Penfornis Paolo Malvezzi Lionel Badet Charles Thivolet Emmanuel Morelon Fanny Buron Eric Renard Igor Tauveron Oriane Villard Marion Munch Salomé Sommacal Léa Clouaire Morgane Jacquet Laura Gonsaud Coralie Camillo-Brault Cyrille Colin Jean-Luc Bosson Domenico Bosco Thierry Berney Laurence Kessler Pierre-Yves Benhamou the GRAGIL Network |
| Affiliation: | 1. Université Grenoble Alpes, LBFA, Grenoble, France;2. Centre Hospitalier Universitaire Jean Minjoz, Service d'Endocrinologie-Métabolisme et Diabétologie-Nutrition, Besançon, France;3. Centre Hospitalier de Montpellier, Pôle Rein Hypertension Métabolisme, Service d'Endocrinologie, Montpellier, France et Département de Médecine, Service d'endocrinologie diabète et métabolisme, Lausanne, Suisse;4. Department of Public Health, University Grenoble Alpes, CNRS, Grenoble University Hospital and TIMC-IMAG, Grenoble, France;5. Service d'endocrinologie, diabétologie et maladies métaboliques, Centre Hospitalier Sud-Francilien, Corbeil-Essonnes, France;6. Service de Néphrologie, Dialyse, Aphérèses et Transplantation, CHU Grenoble Alpes, Grenoble, France;7. Hospices Civils de Lyon, Service d'Urologie et de Chirurgie de la Transplantation, Pôle Chirurgie, Lyon, France;8. Hospices Civils de Lyon, Service d'Endocrinologie Diabète Nutrition, Lyon, France;9. Hospices Civils de Lyon, Service de transplantation, néphrologie et immunologie clinique, Lyon, France;10. CHU de Clermont-Ferrand, Service Endocrinologie-Diabète-Maladies Métaboliques, Clermont Ferrand and UMR GreD CNR56293 INSERM 1103, Université Clermont Auvergne, Clermont-Ferrand, France;11. Service d'endocrinologie diabète et nutrition, Pôle MIRNED, Hôpitaux Universitaires de Strasbourg et Inserm UMR 1260, Nano médecine Régénérative, Université de Strasbourg, Strasbourg, France;12. Department of Endocrinology, Pôle DigiDune, Grenoble University Hospital, Grenoble Alpes, Grenoble, France;13. Hospices Civils de Lyon, Pôle Santé Publique, Service Évaluation Économique en Santé, Lyon, France;14. Departement of Surgery, Islet Isolation, and Transplantation Center, University of Geneva and Geneva University Hospitals, Geneva, Switzerland;15. Université Grenoble Alpes, LBFA, Grenoble, France Department of Endocrinology, Pôle DigiDune, Grenoble University Hospital, Grenoble Alpes, Grenoble, France INSERM, Grenoble, France |
| Abstract: | To describe the 10-year outcomes of islet transplantation within the Swiss-French GRAGIL Network, in patients with type 1 diabetes experiencing high glucose variability associated with severe hypoglycemia and/or with functional kidney graft. We conducted a retrospective analysis of all subjects transplanted in the GRAGIL-1c and GARGIL-2 islet transplantation trials and analyzed components of metabolic control, graft function and safety outcomes over the 10-year period of follow-up. Forty-four patients were included between September 2003 and April 2010. Thirty-one patients completed a 10-year follow-up. Ten years after islet transplantation, median HbA1c was 7.2% (6.2–8.0) (55 mmol/mol [44–64]) versus 8.0% (7.1–9.1) (64 mmol/mol [54–76]) before transplantation (p < .001). Seventeen of 23 (73.9%) recipients were free of severe hypoglycemia, 1/21 patients (4.8%) was insulin-independent and median C-peptide was 0.6 ng/ml (0.2–1.2). Insulin requirements (UI/kg/day) were 0.3 (0.1–0.5) versus 0.5 (0.4–0.6) before transplantation (p < .001). Median (IQR) β-score was 1 (0–4) (p < .05 when comparing with pre-transplantation values) and 51.9% recipients had a functional islet graft at 10 years. With a 10-year follow-up in a multicentric network, islet transplantation provided sustained improvement of glycemic control and was efficient to prevent severe hypoglycemia in almost 75% of the recipients. |
| Keywords: | clinical research/practice diabetes: type 1 endocrinology/diabetology islets of Langerhans |