Islet allo-autotransplantation: allogeneic pancreas transplantation followed by transplant pancreatectomy and islet transplantation

M.F. Nijhoff

Thursday 14 march 2019

13:39 - 13:41h at Tropentheater

Categories: Klinisch/Basaal, Parallelsessie

Parallel session: Parallelsessie XV – Basaal / Klinisch 2

Background: Simultaneous pancreas/kidney (SPK) transplantation is an important treatment option for patients with type 1 diabetes (T1D) and end stage renal disease (ESRD). In up to 10% of cases, allograft pancreatectomy is needed, after which the donor pancreas is normally discarded. But after pancreatectomy of the endogenous pancreas due to benign pancreatic disease, islet isolation and autotransplantation are regularly performed. We report on a novel treatment option for patients who require allograft pancreatectomy: islet allo-autotransplantation.

Methods: A 39 year old woman with T1D and ESRD who had received an SPK transplantation required emergency allograft pancreatectomy due to bleeding at the anastomosis. 478,587 IEQ of islets were isolated from the removed pancreas allograft and infused into the portal vein. The patient recovered fully. After 3 months stable glycemic control without hypoglycemia with only low dose long acting insulin was achieved. Maximal stimulated C-peptide during a mixed meal test was 3.22 nmol/L and HbA1c was 32.7 mmol/mol Hb (5.3%).

Conclusions: When a pancreas transplant is lost, rescue beta cell therapy by islet allo-autotransplantation allows the possibility to optimise glycemic control without additional HLA allo-antigen exposure.