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Attainment of Metabolic Goals in the Integrated UK Islet Transplant Program With Locally Isolated and Transported Preparations

Lookup NU author(s): Dr Gus Brooks, Dr Ali Aldibbiat, Professor Mark Walker, Professor James Shaw

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Abstract

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 HbA(1c) of <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.

Publication metadata

Author(s): 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

Publication type: Article

Publication status: Published

Journal: American Journal of Transplantation

Year: 2013

Volume: 13

Issue: 12

Pages: 3236-3243

Print publication date: 01/12/2013

Online publication date: 01/10/2013

Acceptance date: 10/08/2013

ISSN (print): 1600-6135

ISSN (electronic): 1600-6143

Publisher: Wiley-Blackwell Publishing Ltd.

URL: http://dx.doi.org/10.1111/ajt.12469

DOI: 10.1111/ajt.12469

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