BACKGROUND: Successful islet transplantation can result in insulin independence in many patients with type 1 diabetes mellitus, but it often requires more than one islet infusion. The ability to achieve insulin independence with a single donor is an important goal in clinical islet transplantation due to the limited organ supply. METHODS: We examined factors that may be associated with insulin independence after islet transplantation with islets from a single donor, using univariate and multivariate analysis. RESULTS: Thirteen of 85 (15.3%) achieved insulin independence after single-donor islet transplantation. Using multivariate analysis, only the use of insulin and heparin infusions peritransplant was a significant factor associated with insulin independence, with an adjusted odds ratio of 8.6 (95% confidence interval 2.0-37.0). Patients who had received insulin and heparin infusions peritransplant had greater indices of islet engraftment and a greater reduction in insulin use (80.1% + or - 4.3% vs. 54.2% + or - 2.8%, P<0.001) even if insulin independence was not achieved. CONCLUSIONS: Peritransplant intensive insulin and heparin enhances islet transplantation outcomes likely related in part to mitigation of the effects of the instant blood-mediated inflammatory reaction, combined with islet rest and avoidance of inflammation. It would be important to further investigate the effects of peritransplant insulin and heparin infusions on islet engraftment.
BACKGROUND: Successful islet transplantation can result in insulin independence in many patients with type 1 diabetes mellitus, but it often requires more than one islet infusion. The ability to achieve insulin independence with a single donor is an important goal in clinical islet transplantation due to the limited organ supply. METHODS: We examined factors that may be associated with insulin independence after islet transplantation with islets from a single donor, using univariate and multivariate analysis. RESULTS: Thirteen of 85 (15.3%) achieved insulin independence after single-donor islet transplantation. Using multivariate analysis, only the use of insulin and heparin infusions peritransplant was a significant factor associated with insulin independence, with an adjusted odds ratio of 8.6 (95% confidence interval 2.0-37.0). Patients who had received insulin and heparin infusions peritransplant had greater indices of islet engraftment and a greater reduction in insulin use (80.1% + or - 4.3% vs. 54.2% + or - 2.8%, P<0.001) even if insulin independence was not achieved. CONCLUSIONS: Peritransplant intensive insulin and heparin enhances islet transplantation outcomes likely related in part to mitigation of the effects of the instant blood-mediated inflammatory reaction, combined with islet rest and avoidance of inflammation. It would be important to further investigate the effects of peritransplant insulin and heparin infusions on islet engraftment.
Authors: Barbora Voglová; Martina Zahradnická; Peter Girman; Jan Kríž; Zuzana Berková; Tomáš Koblas; Ema Vávrová; Lenka Németová; Lucie Kosinová; David Habart; Eva Fábryová; Eva Dovolilová; Ivan Leontovyc; Tomáš Neškudla; Jan Peregrin; Jozef Kovác; Kvetoslav Lipár; Matej Kocík; Tomáš Marada; Jirí Svoboda; František Saudek Journal: Rev Diabet Stud Date: 2017-06-12
Authors: Clara T Nicolas; Raymond D Hickey; Kari L Allen; Zeji Du; Rebekah M Guthman; Robert A Kaiser; Bruce Amiot; Aditya Bansal; Mukesh K Pandey; Lukkana Suksanpaisan; Timothy R DeGrado; Scott L Nyberg; Joseph B Lillegard Journal: Surgery Date: 2018-06-06 Impact factor: 3.982
Authors: T Kawahara; T Kin; S Kashkoush; B Gala-Lopez; D L Bigam; N M Kneteman; A Koh; P A Senior; A M J Shapiro Journal: Am J Transplant Date: 2011-08-29 Impact factor: 8.086