Type 1 Diabetes Recurrence After Simultaneous Pancreas-Kidney Transplantation

Purpose of Review: Simultaneous pancreas-kidney transplantation (SPKT) is an importantoption for patients with type 1 diabetes (T1D) and end-stage renal disease.While most SPKT recipients experience long-term euglycemia, about 5% return toinsulin therapy, 5–20 years after transplantation due to T1D recurrence (T1DR).Over the last two decades, we have assessed autoimmunity in our patients,evaluating autoantibodies (GAD65, IA2, and ZnT8), autoreactive T cells, andpancreas transplant biopsies. Recent Findings: Most patients demonstrate seroconversion for multipleautoantibodies. Autoreactive memory T cells have been identified in theperipheral blood, pancreas transplant, and peri-pancreas transplant tissues.Biopsies generally exhibit insulitis, the typical lesion of T1D, affectingpancreatic islets in the pancreas transplant, and lack of rejection in thepancreas and kidney transplants. Summary: In addition to membrane expression of memory markers, we haveidentified other biomarkers, including CXCR3, on circulating and infiltratingautoreactive memory T cells. We hope that this work will lead to therapeuticintervention in our patients with T1DR, and that this will translate toeffective treatment for T1D.