Attainment of metabolic goals in the integrated UK islet transplant program with locally isolated and transported preparations
Brooks AM., Walker N., Aldibbiat A., Hughes S., Jones G., De Havilland J., Choudhary P., Huang GC., Parrott N., McGowan NWA., Casey J., Mumford L., Barker P., Burling K., Hovorka R., Walker M., Smith RM., Forbes S., Rutter MK., Amiel S., Rosenthal MJ., Johnson P., Shaw JAM.
The objective was to determine whether metabolic goals have been achieved with locally isolated and transported preparations over the first 3 years of the UK's nationally funded integrated islet transplant program. Twenty islet recipients with C-peptide negative type 1 diabetes and recurrent severe hypoglycemia consented to the study, including standardized meal tolerance tests. Participants received a total of 35 infusions (seven recipients: single graft; 11 recipients: two grafts: two recipients: three grafts). Graft function was maintained in 80% at [median (interquartile range)] 24 (13.5-36) months postfirst transplant. Severe hypoglycemia was reduced from 20 (7-50) episodes/patient-year pretransplant to 0.3 (0-1.6) episodes/patient-year posttransplant (p < 0.001). Resolution of impaired hypoglycemia awareness was confirmed [pretransplant: Gold score 6 (5-7); 24 (13.5-36) months: 3 (1.5-4.5); p < 0.03]. Target HbA1cof <7.0% was attained/maintained in 70% of recipients [pretransplant: 8.0 (7.0-9.6)%; 24 (13.5-36) months: 6.2 (5.7-8.4)%; p < 0.001], with 60% reduction in insulin dose [pretransplant: 0.51 (0.41-0.62) units/kg; 24 (13.5-36) months: 0.20 (0-0.37) units/kg; p < 0.001]. Metabolic outcomes were comparable 12 months posttransplant in those receiving transported versus only locally isolated islets [12 month stimulated C-peptide: transported 788 (114-1764) pmol/L (n = 9); locally isolated 407 (126-830) pmol/L (n = 11); p = 0.32]. Metabolic goals have been attained within the equitably available, fully integrated UK islet transplant program with both transported and locally isolated preparations. In this report on a cohort of recipients within the UK government-funded fully integrated islet transplant program, the authors demonstrate attainment of metabolic goals with both locally isolated and transported islets with comparable graft survival up to 36 months posttransplant. © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons.