Islet transplantation versus insulin alone in type 1 diabetic kidney transplant recipients: a French nationwide study on behalf of the TREPID group
Mehdi Maanaoui1,2, Remi Lenain1, Yohann Foucher3, Mikael Chetboun2,4, Julie Kerr-Conte2, Gilles Blancho5, Albane Brodin-Sartorius6, Fanny Buron7, Sandrine Lablanche8, Sophie Caillard9, Laurence Kessler10, Thierry Berney11, Marie-Christine Vantyghem2,12, Marc Hazzan1, François Pattou2,4.
1Nephrology, CHU Lille, Lille, France; 2INSERM U1190, University of Lille, Lille, France; 3Plateforme de Méthodologie, CHU Poitiers, Poitiers, France; 4Endocrine Surgery, CHU Lille, Lille, France; 5Nephrology, CHU Nantes, Nantes, France; 6Nephrology, CHU Kremlin-Bicêtre, Kremlin-Bicêtre, France; 7Nephrology, CHU Lyon, Lyon, France; 8Endocrinology, CHU Grenoble, Grenoble, France; 9Nephrology, CHU Strasbourg, Strasbourg, France; 10Endocrinology, CHU Strasbourg, Strasbourg, France; 11Cell Isolation and Transplantation Center, University of Geneva, Geneva, Switzerland; 12Endocrinology, CHU Lille, Lille, France
TREPID group.
Background: Islet transplantation is associated with a benefit on glycaemic control compared to optimized insulin therapy in recent clinical trials. However, there is a lack of evidence concerning the long-term impact of islet transplantation on type 1 diabetic kidney transplant recipients’ prognosis.
Method: Every type 1 diabetic recipient transplanted with a kidney in France between 2000 and 2017 was included. Patients transplanted with pancreatic islets were compared to controls treated with insulin alone according to a matching method based on time-dependent propensity scores (using the following variables : yera of transplantation, donor age, and recipient age, serum creatinine, HBA1c, BMI, cardiovascular background) which allow to ensure patients comparability at the time of islet transplantation. The primary outcome was graft failure, defined by death or return to dialysis.
Results: Among 2393 type 1 diabetic patients transplanted with a kidney during the study period, 381 were eligible to islet transplantation, including 47 that were actually transplanted with islets. Median time for islet transplantation was 34.8 months [21.8-48.4]. Probabilities of insulino-independence and islet graft survival at 1, 5 and 10 years were respectively 63.8% [51.5-79.2], 46.3% [33.9-63.2], 38.7% [25.9-57.8] and 89.4% [81.0-98.6], 87.2% [78.2-97.3], 78.2% [66.2-92.4]. After matching, we observed a significant benefit of islet transplantation compared to insulin alone on graft failure, with a HR of 0.48 [0.20-0.94], mainly explained by a protective effect on the risk of death (HR= 0.38 [0.11-0.95]). We finally estimated the life-expectancy for a 10-year follow-up and found 9.61 years [9.02-10.00] in the islet transplantation group versus 8.85 years [7.97-9.56], with a difference of 8.88 months [-2.16-20.44]
Conclusion: We observe a significant benefit of islet transplantation on the risk of graft failure and death in type 1 diabetic kidney transplant recipients. These results provide incentives to promote islet transplantation in this population.
Lectures by Mehdi Maanaoui
| When | Session | Talk Title | Room |
|---|---|---|---|
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Sat-28 16:00 - 17:30 |
Islet transplant: Clinical Studies in Islet Allo and Auto-Transplantation | Islet transplantation versus insulin alone in type 1 diabetic kidney transplant recipients: a French nationwide study on behalf of the TREPID group | Indigo A |