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The impact of islet mass, number of transplants, and time between transplants on graft function in a national islet transplant program

Lookup NU author(s): Dr Anneliese Flatt, Professor James Shaw

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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).

Abstract

© 2021 The Authors. American Journal of Transplantation published by Wiley periodicals LLC on behalf of the The American Society of Transplantation and the American Society of Transplant Surgeons.The UK islet allotransplant program is nationally funded to deliver one or two transplants over 12 months to individuals with type 1 diabetes and recurrent severe hypoglycemia. Analyses were undertaken 10 years after program inception to evaluate associations between transplanted mass; single versus two transplants; time between two transplants and graft survival (stimulated C-peptide >50 pmol/L) and function. In total, 84 islet transplant recipients were studied. Uninterrupted graft survival over 12 months was attained in 23 (68%) single and 47 (94%) (p =.002) two transplant recipients (separated by [median (IQR)] 6 (3–8) months). 64% recipients of one or two transplants with uninterrupted function at 12 months sustained graft function at 6 years. Total transplanted mass was associated with Mixed Meal Tolerance Test stimulated C-peptide at 12 months (p <.01). Despite 1.9-fold greater transplanted mass in recipients of two versus one islet infusion (12 218 [9291–15 417] vs. 6442 [5156–7639] IEQ/kg; p <.0001), stimulated C-peptide was not significantly higher. Shorter time between transplants was associated with greater insulin dose reduction at 12 months (beta −0.35; p =.02). Graft survival over the first 12 months was greater in recipients of two versus one islet transplant in the UK program, although function at 1 and 6 years was comparable. Minimizing the interval between 2 islet infusions may maximize cumulative impact on graft function.

Publication metadata

Author(s): Forbes S, Flatt AJ, Bennett D, Crookston R, Pimkova M, Birtles L, Pernet A, Wood RC, Burling K, Barker P, Counter C, Lumb A, Choudhary P, Rutter MK, Rosenthal M, Sutherland A, Casey J, Johnson P, Shaw JAM

Publication type: Article

Publication status: Published

Journal: American Journal of Transplantation

Year: 2021

Volume: 10

Issue: 16

Online publication date: 18/08/2021

Acceptance date: 17/08/2021

Date deposited: 03/11/2023

ISSN (print): 1600-6135

ISSN (electronic): 1600-6143

Publisher: John Wiley and Sons Inc

URL: https://doi.org/10.1111/ajt.16785

DOI: 10.1111/ajt.16785

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