Resumen de Improvement in Outcomes of Clinical Islet Transplantation: 1999-2010
Franca B Barton, Michael R Rickels, Rodolfo Alejandro, Bernhard J. Hering, Stephen Wease, Bashoo Naziruddin, Jose Oberholzer, Jon S Odorico, Marlon Levy, Francois Pattou, Thierry Berney, Antonio Secchi, Shari Messinger, Peter A Senior, Paola Maffi, Andrew Posselt, Peter G. Stock, Dixon B Kaufman, Xunrong Luo, Fouad Kandeel, Enrico Cagliero, Nicole Turgeon, Piotr Witkowski, Ali Naji, Philip J O'Connell, Carla Greenbaum, Yogish C Kudva, Kenneth L Brayman, Meredith J Aull, Christian Larsen, Tom W. H. Kay, Luis A Fernandez, Marie-Christine Vantyghem, Melena Bellin, A M James Shapiro
To describe trends of primary efficacy and safety outcomes of islet transplantation in type 1 diabetes recipients with severe hypoglycemia from the Collaborative Islet Transplant Registry (CITR) from 1999 to 2010. A total of 677 islet transplant-alone or islet-after-kidney recipients with type 1 diabetes in the CITR were analyzed for five primary efficacy outcomes and overall safety to identify any differences by early (1999-2002), mid (2003-2006), or recent (2007-2010) transplant era based on annual follow-up to 5 years. Insulin independence at 3 years after transplant improved from 27% in the early era (1999-2002, n = 214) to 37% in the mid (2003-2006, n = 255) and to 44% in the most recent era (2007-2010, n = 208; P = 0.006 for years-by-era; P = 0.01 for era alone). C-peptide =0.3 ng/mL, indicative of islet graft function, was retained longer in the most recent era (P < 0.001). Reduction of HbA^sub 1c^ and resolution of severe hypoglycemia exhibited enduring long-term effects. Fasting blood glucose stabilization also showed improvements in the most recent era. There were also modest reductions in the occurrence of adverse events. The islet reinfusion rate was lower: 48% by 1 year in 2007-2010 vs. 60-65% in 1999-2006 (P < 0.01). Recipients that ever achieved insulin-independence experienced longer duration of islet graft function (P < 0.001). The CITR shows improvement in primary efficacy and safety outcomes of islet transplantation in recipients who received transplants in 2007-2010 compared with those in 1999-2006, with fewer islet infusions and adverse events per recipient.
