2011 - IPITA - Prague


Parallel session 2 – Open oral presentations Topic: Results of clinical autologous and allogeneic islet transplantation

2.2 - Insulin independence and metabolic outcomes in a large cohort of total pancreatectomy and islet autotransplant recipients

Presenter: M., Bellin, Minneapolis, USA
Authors: M. Bellin, G. Beilman, T. Dunn, S. Chinnakotla, A.N. Balamurugan, B. Bland, S. Vickers, B. Hering, D. Sutherland



Insulin independence and metabolic outcomes in a large cohort of total pancreatectomy and islet autotransplant recipients

M. Bellin1, G. Beilman2, T. Dunn2, S. Chinnakotla2, A.N. Balamurugan1, B. Bland2, S. Vickers2, B. Hering1, D. Sutherland1
1 University of Minnesota, Schulze Diabetes Institute, Minneapolis, USA; 2 University of Minnesota, Minneapolis, USA

Background: Intraportal slet autotransplant (IAT) is performed at the time of surgical pancreatectomy to prevent or minimize post-surgical diabetes. A large series allowed us to study islet function, in the absence of immunologic variables.

Methods: 300 IATs were performed at our center over 32 years (2/77-2/09). Excluding partial pancreatectomies, 279 cases were total or near total pancreatectomy, with follow up data available for 236. Since 2006, patients underwent hemoglobin A1c and mixed meal testing before and annually after surgery. Insulin use was obtained from medical records and patient questionnaires.

Results: Mean age at surgery was 36 ± 13 years; mean islet mass transplanted was 3,385±2,028 IE/kg. Preoperatively, average HbA1c was 5.3±0.6%, fasting glucose 90±18 mg/dL, and stimulated C-peptide 5.1±2.1 ng/mL. IE/kg weakly correlated with preoperative HbA1c (r=-0.28, p=0.004) and stimulated C-peptide (r=+0.19, p=0.05). Overall, 36% (n=101) of patients achieved insulin independence (II). II was highest in those receiving >5,000 IE/kg (table 1). At 1-2 years posttransplant, mean HbA1c was 6.7±1.5%, and was lower in II recipients (5.7±0.3% vs 7.3±1.7% in insulin dependent). HbA1c was <7% in 72%. 88% were C-peptide positive, including 100% of those receiving>2,500 IE/kg.

IE/kg Transplanted

<2,500

2,500-5,000

>5,000

p-value

N (total)

103

117

59

Follow up data available (n)

82

99

48

Achieved Insulin Independence n (%)

8(10%)

51(52%)

39(81%)

<0.0001

HbA1c (%)*

7.8±2.0

6.2±1.0

5.9±0.4

<0.0001

Fasting glucose (mg/dL)*

179±150

98±17

94±18

0.01

Fasting C-peptide (ng/mL)*

1.0±0.2

1.1±0.1

1.4±0.3

0.45

Peak C-peptide (ng/mL)*

1.6±1.4

2.8±1.5

3.7±1.4

0.001

% C-peptide positive (>0.5 ng/mL)*

67%

100%

100%

0.003

*results at 1-2 years posttransplant

 

Conclusions: Consistent with prior reports, II rates were highest in IAT recipients with the greatest islet mass (>5000 IE/kg). However, even with lower yields, most are C-peptide positive, and IAT permitted goal glycemic control in the majority.


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