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Saturday October 28, 2023 - 09:35 to 10:35

Room: Indigo 204

318.4 Pancreas after islet and islet after pancreas transplantation offer a durable insulin independence to patients with type 1 diabetes mellitus and problematic hypoglycemia.

Sarah Gondek, United States

Clinical Research Coordinator
University of Chicago

Abstract

Pancreas after islet and islet after pancreas transplantation offer a durable insulin independence to patients with type 1 diabetes mellitus and problematic hypoglycemia

Sarah Gondek 1, Mateusz Ogledzinski1, William Lin1, Kamila Milejczyk1, Piotr Bachul1, Braden Juengel1, Lindsay Basto1, Laurencia Perea1, Lingjia Wang1, Rolf Barth1, John J Fung1, Piotr Witkowski1.

1Surgery, University of Chicago, Chicago, IL, United States

Background: Islet, as well as pancreas transplantations, are alternative procedures providing diabetic patients with insulin independence and optimal blood glucose control. Here, we assessed the utility of islet transplantation after the failure of a pancreas graft and the utility of pancreas transplantation in patients with declining islet graft function. 

Materials and Methods: Four patients with insulin-deficient diabetes and problematic hypoglycemia were transplanted with islets allografts after the failure of prior pancreas transplants (IAP). Another four patients who had previously received islet allotransplants were transplanted with a pancreas after their islet graft function declined (PAI patients). Tacrolimus and mycophenolate were used for immunosuppression supplemented with steroids for PAI patients. 

Results: All four IAP patients became insulin independent after their first islet transplant. Two remained insulin independent 11 and 12 months later; the remaining two patients required a second ITx to extend insulin independence over 3 years and one of them a third ITx to extend freedom from insulin over 8 years. 

All 4 patients receiving PAI had uncomplicated clinical courses and maintained optimal blood glucose control without insulin more than 4 years after the pancreas transplant. None of the patients developed de novo HLA antibodies after PAI or IAP transplantation. 

Conclusions: Pancreas and islet transplantations are alternative beta cell replacement transplant procedures, allowing successful extension of  insulin independence in case one type of those therapies had initially failed. 

The study was supported by the Dompe ́ Farmaceutici S.p.A. The authors would like to acknowledge the generosity and support of Dr. Martin Jendrisak and the entire team of the Gift of Hope Organ & Tissue Donor Network in Chicago, NJ Sharing Network, Lifebanc Ohio for providing the human pancreas tissues used in the present study. We also acknowledge support from the NIDDK P30 DK020595 and the Kovler Family Fund..

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