Original Research

Improvement in Outcomes of Clinical Islet Transplantation: 1999–2010

  1. Franca B. Barton, MS1⇓,
  2. Michael R. Rickels, MD2,
  3. Rodolfo Alejandro, MD3,
  4. Bernhard J. Hering, MD4,
  5. Stephen Wease, MPH1,
  6. Bashoo Naziruddin, PHD5,
  7. Jose Oberholzer, MD6,
  8. Jon S. Odorico, MD7,
  9. Marc R. Garfinkel, MD8,
  10. Marlon Levy, MD9,
  11. Francois Pattou, MD, PHD10,
  12. Thierry Berney, MD11,
  13. Antonio Secchi, MD12,
  14. Shari Messinger, PHD3,
  15. Peter A. Senior, PHD, MRCP13,
  16. Paola Maffi, MD, PHD12,
  17. Andrew Posselt, MD, PHD14,
  18. Peter G. Stock, MD, PHD14,
  19. Dixon B. Kaufman, MD, PHD7,
  20. Xunrong Luo, MD, PHD15,
  21. Fouad Kandeel, MD, PHD16,
  22. Enrico Cagliero, MD17,
  23. Nicole A. Turgeon, MD18,
  24. Piotr Witkowski, MD, PHD19,
  25. Ali Naji, MD, PHD2,
  26. Philip J. O’Connell, MD, PHD20,
  27. Carla Greenbaum, MD21,
  28. Yogish C. Kudva, MD22,
  29. Kenneth L. Brayman, MD, PHD23,
  30. Meredith J. Aull, PHARMD24,
  31. Christian Larsen, MD, PHD18,
  32. Tom W.H. Kay, MD, PHD25,
  33. Luis A. Fernandez, MD7,
  34. Marie-Christine Vantyghem, MD, PHD10,
  35. Melena Bellin, MD4 and
  36. A.M. James Shapiro, MD, PHD13
  1. 1The EMMES Corporation, Rockville, Maryland
  2. 2Department of Surgery, Division of Endocrinology, Diabetes and Metabolism, University of Pennsylvania, Philadelphia, Pennsylvania
  3. 3Department of Medicine, Division of Endocrinology/Diabetes/Metabolism, University of Miami, Miami, Florida
  4. 4Schultze Diabetes Institute and Department of Surgery, University of Minnesota, Minneapolis, Minnesota
  5. 5Islet Processing Laboratory, Institute of Biomedical Science, Baylor University Medical Center, Dallas, Texas
  6. 6Department of Surgery, Division of Transplant Surgery, University of Illinois at Chicago, Chicago, Illinois
  7. 7Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, Wisconsin
  8. 8Department of Surgery, Division of General Surgery, Southern Illinois University, Springfield, Illinois
  9. 9Department of Transplant Services, University of Texas, Southwest Medical School, Dallas, Texas
  10. 10Department of General and Endocrine Surgery, Lille University, Lille, France
  11. 11Department of Surgery, Division of Transplantation and Visceral Surgery, Geneva University Hospital, Geneva, Switzerland
  12. 12Department of Internal Medicine, San Raffaele University, Milan, Italy
  13. 13Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, Alberta, Canada
  14. 14Department of Surgery, University of California, San Francisco, San Francisco, California
  15. 15Department of Medicine, Northwestern University, Chicago, Illinois
  16. 16Division of Diabetes, Endocrinology & Metabolism, City of Hope, Duarte, California
  17. 17 MGH Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts
  18. 18Department of Surgery, Division of Transplantation Emory University, Atlanta, Georgia
  19. 19Department of Surgery, University of Chicago, Chicago, Illinois
  20. 20Centre for Transplant and Renal Research, Westmead Hospital, Westmead, New South Wales, Australia
  21. 21Diabetes Program, Benaroya Research Institute, Seattle, Washington
  22. 22Department of Endocrinology, Mayo Clinic, Rochester, Minnesota
  23. 23Department of Transplantation Surgery, University of Virginia, Charlottesville, Virginia
  24. 24Division of Transplantation Surgery, Weill-Cornell Medical College, New York, New York
  25. 25Department of Medicine, St. Vincent’s Institute, Fitzroy, Victoria, Australia
  1. Corresponding author: Franca B. Barton, fbarton{at}emmes.com.
Diabetes Care 2012 Jul; 35(7): 1436-1445. https://doi.org/10.2337/dc12-0063

Article Figures & Tables

Figures

  • Figure 1
    Figure 1

    Islet allograft recipients (N = 677) registered in CITR according to type of transplant (n per year; top), induction immunosuppression at first infusion (% by year; center), and maintenance immunosuppression at first infusion (% by year; bottom). ITA, islet transplant alone.

  • Figure 2
    Figure 2

    A: Rates of insulin independence after allogeneic islet infusion (islet transplant alone and IAK), annually after last infusion. Left: By era (P = 0.02). Right: By induction immunosuppression category (P < 0.01). B: Durability of graft function (basal C-peptide ≥0.3 ng/mL) after the last infusion, by era (P < 0.001; left). The immediate drop at time 0 is occurrences of primary nonfunction (i.e., C-peptide never ≥0.3 ng/mL). In the most recent era, 95% of those who ever achieved insulin independence (II) retained graft function through 3 years after last infusion compared with 70% for those who never achieved II (P < 0.001; right). C: Percentage of patients with HbA1c <6.5% or drop by two percentage points (P = 0.03; left); and absence of severe hypoglycemic events regardless of complete graft failure (P = NS by era; there were insufficient data from 2007–2010; right). D: The percentage with HbA1c <6.5% or drop by 2% increases with increasing C-peptide level (P < 0.001; left), as does absence of severe hypoglycemic events (P < 0.001; right), annually after the last infusion. (A high-quality color representation of this figure is available in the online issue.)

  • Figure 3
    Figure 3

    A: Mortality by era (P = 0.49). B: Life-threatening events by era (P = 0.01). C: Incidence of any adverse event (AE) in year 1 of first infusion (P = 0.02 by era). D: CKD-EPI calculated glomerular filtration rate, by era.

Tables

  • Table 1
  • Table 2
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Improvement in Outcomes of Clinical Islet Transplantation: 1999–2010
Franca B. Barton, Michael R. Rickels, Rodolfo Alejandro, Bernhard J. Hering, Stephen Wease, Bashoo Naziruddin, Jose Oberholzer, Jon S. Odorico, Marc R. Garfinkel, Marlon Levy, Francois Pattou, Thierry Berney, Antonio Secchi, Shari Messinger, Peter A. Senior, Paola Maffi, Andrew Posselt, Peter G. Stock, Dixon B. Kaufman, Xunrong Luo, Fouad Kandeel, Enrico Cagliero, Nicole A. Turgeon, Piotr Witkowski, Ali Naji, Philip J. O’Connell, Carla Greenbaum, Yogish C. Kudva, Kenneth L. Brayman, Meredith J. Aull, Christian Larsen, Tom W.H. Kay, Luis A. Fernandez, Marie-Christine Vantyghem, Melena Bellin, A.M. James Shapiro
Diabetes Care Jul 2012, 35 (7) 1436-1445; DOI: 10.2337/dc12-0063
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