The seemingly unavoidable decline in insulin independence after islet transplant alone (ITA) has raised concern about its clinical utility. This study investigated the relationship between induction immunosuppression therapy (the potent medications that are given during and immediately after a transplant for a few days to prevent rejection) and the length of insulin independence. The authors analyzed the proportion of insulin-independent patients following final islet infusion in four groups of ITA recipients according to induction immunotherapy: 1) anti-CD3 antibody alone or T-cell depleting antibodies and TNF-alpha inhibition; 2) T-cell depleting antibodies and TNF-alpha inhibition; 3) T-cell depleting antibodies alone; or 4) IL-2 receptor antibodies alone. Results were compared with outcomes in a group of pancreas transplant alone (PTA) recipients. The 5-year insulin independence rates in group 1 (50%) and group 2 (50%) were comparable to outcomes in PTA (52%) but significantly higher than in group 3 (0%) and group 4 (20%). Induction immunosuppression was significantly associated with 5-year insulin independence regardless of maintenance immunosuppression or other factors. These findings support the potential for higher long-term insulin independence after ITA using potent induction therapy, with anti-CD3 antibody or T-cell depleting antibodies and TNF-alpha inhibition.
Bellin MD, Barton FB, Heitman A, Harmon JV, Kandaswamy R, Balamurugan AN, Sutherland DE, Alejandro R, Hering BJ. Potent Induction Immunotherapy Promotes Long-Term Insulin Independence After Islet Transplantation in Type 1 Diabetes. Am J Transplant. June 2012;12(6):1576-83.
Investigators and Institutions:
This data analysis was performed by Dr. Hering and his colleagues at the University of Minnesota and University of Miami, and the scientists at the Collaborative Islet Transplant Registry (CITR).
Ramifications for Individuals with Type 1 Diabetes:
Islet transplantation is one of the few options for patients with life-threating severe hypoglycemic episodes. This study suggests new procedures to improve the long-term insulin-independence rate among patients undergoing an islet transplant.
JDRF provided funding to many of the clinical centers that performed islet transplants and contributed data to the registry. JDRF is also funding CITR to include data from outside the North America.