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 LuoFouad 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

Research output: Contribution to journalArticle

440 Scopus citations

Abstract

OBJECTIVE - To describe trends of primary efficacy and safety outcomes of islet transplantation in type 1 diabetes recipients with severe hypoglycemia from the Collaborative Islet Transplant Registry (CITR) from 1999 to 2010. RESEARCH DESIGN AND METHODS - A total of 677 islet transplant-alone or isletafter- kidney recipients with type 1 diabetes in the CITR were analyzed for five primary efficacy outcomes and overall safety to identify any differences by early (1999-2002), mid (2003-2006), or recent (2007-2010) transplant era based on annual follow-up to 5 years. RESULTS - Insulin independence at 3 years after transplant improved from 27% in the early era (1999-2002, n = 214) to 37% in the mid (2003-2006, n = 255) and to 44% in the most recent era (2007-2010, n = 208; P = 0.006 for years-by-era; P = 0.01 for era alone). C-peptide ≥0.3 ng/mL, indicative of islet graft function,was retained longer in themost recent era (P<0.001). Reduction of HbA1c and resolution of severe hypoglycemia exhibited enduring long-term effects. Fasting blood glucose stabilization also showed improvements in the most recent era. There were also modest reductions in the occurrence of adverse events. The islet reinfusion rate was lower: 48% by 1 year in 2007-2010 vs. 60-65% in 1999-2006 (P < 0.01). Recipients that ever achieved insulinindependence experienced longer duration of islet graft function (P < 0.001). CONCLUSIONS - The CITR shows improvement in primary efficacy and safety outcomes of islet transplantation in recipients who received transplants in 2007-2010 compared with those in 1999-2006, with fewer islet infusions and adverse events per recipient.

Original languageEnglish (US)
Pages (from-to)1436-1445
Number of pages10
JournalDiabetes care
Volume35
Issue number7
DOIs
StatePublished - Jul 1 2012

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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    Barton, F. B., Rickels, M. R., Alejandro, R., Hering, B. J., Wease, S., Naziruddin, B., Oberholzer, J., Odorico, J. S., Garfinkel, M. R., Levy, M., Pattou, F., Berney, T., Secchi, A., Messinger, S., Senior, P. A., Maffi, P., Posselt, A., Stock, P. G., Kaufman, D. B., ... Shapiro, A. M. J. (2012). Improvement in outcomes of clinical islet transplantation: 1999-2010. Diabetes care, 35(7), 1436-1445. https://doi.org/10.2337/dc12-0063