Kidney Function after Islet Transplant Alone in Type 1 Diabetes: Impact of Immunosuppressive Therapy on Progression of Diabetic Nephropathy

Abstract

Abstract Objective. Islet transplantation alone (ITA) is an alternative for the replacement of pancreatic endocrine function in patients with type 1 diabetes. The aim of our study was to assess the impact of the Edmonton immunosuppressive protocol (tacrolimus-sirolimus association) on kidney function.

Abstract Research design and methods. 19 patients with type 1 diabetes and metabolic instability received islet transplantation alone and immunosuppressive therapy according to the Edmonton protocol. Serum creatinine (sCr), creatinine clearance (ClCr) and 24 hour urinary protein excretion (24h UPE) was assessed at baseline and during a follow-up of 339 patient month.

Abstract Results After islet transplantation we observed: 1) sCr within the normal range in all but two patients where sCr increased immediately after islet transplantation, despite immunosuppression withdrawal patients progressed toward end-stage renal disease (ESRD); 2) ClCr remained within the normal range for those patients who had normal baseline and decreased progressing toward ESRD in two patients with a decreased baseline CrCl; and 3) 24hUPE worsened (>300 mg/24 hours) in four patients. In the two patients who progressed to ESRD the worsening of 24hUPE occurred immediately after islet transplantation. In one patient 24hUPE worsening occurred at 18 months: after withdrawal of immunosuppression it returned within the normal range. In another patient 24hUPE increased at 24 months stable while continuing immunosuppression

Abstract Conclusions. In type 1 diabetic patients receiving ITA, the association of tacrolimus-sirolimus should be used only in patients with normal kidney function. Alternative options for immunosuppressive treatment should be considered for patients with even a mild decrease of kidney function.