Islets isolated from donors with elevated HbA1c can be successfully transplanted.

Clinical islet transplantation is limited by the availability of donor organs. We report two cases where islets were isolated from donors with elevated HbA1c (6.3% and 7.9%). Islet isolation yield was adequate in both cases (521,350 and 497,472 islet equivalents, respectively). Islet graft analyses revealed a decreased proportion of beta cells (21.6%) and an increase in alpha cells (51.0%) in the donor with the higher HbA1c, although graft characteristics of the other donor were similar to donors with normal HbA1c. Both islet preparations were transplanted into type 1 diabetes recipients with brittle diabetes. One recipient has remained insulin independent for 4 years to date with good glycemic control. The other recipient who received islets from the donor with the higher HbA1c had a 56% reduction in insulin requirement after transplant. Pancreases from donors with mild hyperglycemia may be a source of islets that could be considered for clinical islet transplantation.