Recurrence of type 1 diabetes following simultaneous pancreas-kidney transplantation

George W. Burke, Gaetano Ciancio, Mahmoud Morsi, Jose Figueiro, Linda Chen, Francesco Vendrame, Alberto Pugliese

Research output: Chapter in Book/Report/Conference proceedingChapter

1 Scopus citations

Abstract

Simultaneous pancreas-kidney transplantation (SPKT) is an important option for patients with type 1 diabetes (T1D) and end-stage renal disease. While most SPKT recipients experience long-term euglycemia, about 5%, return to insulin therapy, 5-20 years after transplantation due to T1D recurrence (T1DR). Over the last two decades, we have assessed autoimmunity in our patients, evaluating T1D-associated autoantibodies (GAD65, IA2, and ZnT8), autoreactive T cells against islet antigens, and pancreas transplant biopsies. Most patients with T1DR demonstrate seroconversion for multiple autoantibodies. Autoreactive memory T cells have been identified in their peripheral blood, pancreas transplant, and peripancreas transplant tissues. Biopsies generally exhibit insulitis, the typical lesion of T1D, affecting pancreatic islets in the pancreas transplant. In addition to membrane surface expression of memory markers, we have identified other biomarkers, including CXCR3, on circulating and infiltrating autoreactive memory T cells. We hope that this work will lead to therapeutic intervention in our patients with T1DR, and that this will translate to effective treatment for T1D.

Original languageEnglish (US)
Title of host publicationTransplantation, Bioengineering, and Regeneration of the Endocrine Pancreas
Subtitle of host publicationVolume 1
PublisherElsevier
Pages295-311
Number of pages17
ISBN (Electronic)9780128148334
ISBN (Print)9780128148341
DOIs
StatePublished - Jan 1 2019

Keywords

  • Autoantibodies
  • Autoimmunity
  • Autoreactive T cells
  • Memory T cells
  • Pancreas transplant
  • Regulatory T cells (T regs)
  • TH1 lymphocytes
  • TH17 lymphocytes
  • Type 1 diabetes (T1D)
  • Type 1 diabetes recurrence (T1DR)

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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