Wednesday 13 march 2019
17:00 - 17:10h at Tropentheater
Categories: Best abstracts, Parallelsessie
Parallel session: Parallelsessie VIII – Best abstracts II
Pancreatic islet transplantation is performed at the Leiden University Medical Center since 2007. Starting as an experimental procedure, it is now increasingly commonplace. Here we describe the indications, procedure, and outcomes of pancreatic islet transplantation in The Netherlands.
Methods: Indications for allogeneic islet transplantation included patients with severe beta cell failure, such as type 1 or cystic fibrosis-related diabetes, in combination with severe hypoglycemia-related problems and/or progressive complications. Islet autotransplantation was performed in patients who required pancreatectomy for non-malignant pancreatic disease (i.e. chronic pancreatitis). Islet isolation was performed through combined enzymatic and mechanical digestion of the pancreas, followed by gradient density separation. The final product was tested for function and safety, after which the islets were infused through the portal vein under local anesthesia. Immunosuppression, when indicated, included T-cell depletion, prednisolone, mycophenolate and tacrolimus.
Results: 35 patients (21M/14F, age 51±10.3 years) underwent 55 allogeneic and two autologous islet transplantations. Islet graft function occurred in 34/35 of recipients with 46% of patients becoming insulin independent. Over time islet function declined, with insulin independence in 14% and partial islet function in 89% of patients after 47.9±30.0 months (range 4-123). HbA1c was reduced from 66.8±16.8 to 52.8±16.2 mmol/mol (p<0.001). In addition, patients with severe hypoglycemic events decreased from 39% to 6%.
Conclusion: Pancreatic islet transplantation restores endogenous insulin production in patients with diabetes due to severe beta cell failure or after pancreatectomy, leading to marked improvement in glycemic regulation and hypoglycemic events. Long term insulin independence is achieved only in a minority.