CLINICAL ISLET TRANSPLANTATION

N. Niclauss¹, D. Bosco², P. Morel¹, S. Demuylder-mischler¹, C. Brault³, G. Parnaud⁴, L. Giovannoni⁵, L. Badet⁶, P. Benhamou⁷, T. Berney^1
1Visceral And Transplantation Surgery, Geneva University Hospitals, Geneva/SWITZERLAND, ²Islet Isolation And Tranplantation Center, Geneva University Hospitals, Geneva/SWITZERLAND, ³Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, Lyon/FRANCE, ⁴Islet Isolation And Transplantation Center, Department Of Surgery, University of Geneva and Geneva University Hospital, Geneva/SWITZERLAND, ⁵Surgery, Cell isolation and transplantation center, Geneva/SWITZERLAND, ⁶Service De Chirurgie Urologique Et De La Transplantation, Hôpital E Herriot HCL, Lyon/FRANCE, ⁷Clinique D'endocrinologie Diabétologie Nutrition, CHU de Grenoble, Grenoble/SWITZERLAND

Body: Introduction: It has been suggested that the age of human organ donors might influence islet isolation and transplantation outcome in a negative way due to a decrease of in vivo function in islets isolated from older donors. Methods: We retrospectively analyzed 332 islet isolations performed between January 2002 and September 2008 and divided them into two groups depending on donor age (n=145 and n=187 for ≤45 and >45 years, respectively). Pancreata were procured and processed according to established protocols. Isolation outcome was determined by islet yield, success rate (>250’000 IEQ) and transplantation rate. Beta cell function was assessed in vitro by stimulation index in static incubation assays. Transplanted patients were divided into two groups depending on donor age (n=25 and n=32 patients who received islets from ≤45 and >45 year-old donors only, respectively). We assessed islet graft function by the newly developed secretory units of islets in transplantation (SUIT) index, C-peptide/glucose ratio, ß-score and insulin independence rate at one and six months after transplantation. Results: There was no difference in islet yields between the two groups (251,900 ± 14,100 and 244,600 ± 8,400 IEQ for ≤45 and >45 year-old donors, respectively). Success rates were 40% and 45% for ≤45 and >45 year-old donors, respectively. Overall 64 (44%) islet preparations were transplanted from ≤45 year-old donors and 77 (41%) islet preparations were transplanted from >45 year-old donors. Stimulation indices were similar for both groups. At one month after transplantation, SUIT indices and C-peptide/glucose ratios were significantly higher in patients who had received islets from ≤45 year-old donors (49.4 ± 5.1 vs. 33.3 ± 4.4, p=0.02 and 1.44 ± 0.14 vs. 0.89 ± 0.08, p=0.0004; respectively). Similarly, ß-scores and insulin independence rates at 1 month after transplantation were significantly higher in patients who had received islets from the younger donor population (4.6 ± 0.2 vs. 3.8 ± 0.2, p=0.04 and 29.2% vs. 6.5%, p<0.05; respectively). At six months after 2nd and 3rd injection, SUIT indices and C-peptide/glucose ratios were significantly higher in patients with ≤45 year-old donors (61.5 ± 7.7 vs. 37.8 ± 6.3, p=0.03 and 1.90 ± 0.20 vs. 1.11 ± 0.17, p=0.006; respectively), whereas no difference was observed in ß-scores and insulin independence rates. Conclusion: Our study shows that, in our donor population, islet graft function is significantly influenced by donor age, in spite of similar isolation outcome parameters.

Disclosure: All authors have declared no conflicts of interest.