P-174

Human pancreatic islet isolation and transplantation at the Institute for Clinical and Experimental Medicine

E. Dovolilova, P. Girman, J. Kriz, Z. Berkova, K. Zacharovova, T. Koblas, L. Pektorova, M. Mindlova, E. Vavrova, I. Leontovyc, D. Habart, E. Cihalova, F. Saudek
Institute for Clinical and Experimental Medicine, Laboratory of Langerhans Islets, Prague, Czech Republic

Objective: Islet transplantation is an optional treatment indicated for selected type 1 diabetic (T1DM) recipients with hypoglycaemia unawareness syndrome or for high risk diabetic kidney recipients. The aim of the study was to evaluate the results of islet transplantations carried out in our centre.

Methods: For pancreatic islet isolation we use cadaveric pancreases which are not suitable for organ transplantation in terms of age and BMI. Isolation process and transplantation of the pancreatic islets was inspired by the Edmonton protocol and personal experience in Geneva and Uppsala. We analyzed graft function, rate of complications and patient survival.

Results: Since 2005 191 islet isolations and 46 islet transplantations were performed in 30 recipients. Five patients underwent autotransplantation, 3 received the liver with islets and another 5 patients underwent islet-after-kidney transplantation. 17 patients received pancreatic islets alone, 7 recipients had one islet infusion, 4 recipients had 2 infusions and 6recipients had 3 infusions. In all but 2 subjects the C-peptide levels significantly increased and their daily insulin doses decreased by 50% or more. Only 3 subjects could be completely off insulin. In 5 of 7 recipients with hypoglycaemia unawareness syndrome was successfully treated. We have recorded 4 cases of bleedings, 1 puncture of biliary tract and 1 vasovagal syncope. Two patients required surgery due to bleeding. All other complications resolved spontaneously. Mean (±SD) fasting c-peptide level increased from 0.02±0.02 to 0.2±2ng/ml. Mean daily dose of insulin decreased to about one third of the pretransplant dose. (from 37±11 to 15±7 IU). Mean HbA₁c decreased from 7.6±1.8 to 5.3±0.9%.

Conclusions: In comparison with organ pancreas transplantation, the islet transplantation represents a safe but still less effective method of diabetes treatment. Results might be improved by achieving a higher islet yield and by selection if organs with better quality for islet isolation.

MZO 00023001

P-174

Human pancreatic islet isolation and transplantation at the Institute for Clinical and Experimental Medicine

E. Dovolilova, P. Girman, J. Kriz, Z. Berkova, K. Zacharovova, T. Koblas, L. Pektorova, M. Mindlova, E. Vavrova, I. Leontovyc, D. Habart, E. Cihalova, F. Saudek
Institute for Clinical and Experimental Medicine, Laboratory of Langerhans Islets, Prague, Czech Republic

Objective: Islet transplantation is an optional treatment indicated for selected type 1 diabetic (T1DM) recipients with hypoglycaemia unawareness syndrome or for high risk diabetic kidney recipients. The aim of the study was to evaluate the results of islet transplantations carried out in our centre.

Methods: For pancreatic islet isolation we use cadaveric pancreases which are not suitable for organ transplantation in terms of age and BMI. Isolation process and transplantation of the pancreatic islets was inspired by the Edmonton protocol and personal experience in Geneva and Uppsala. We analyzed graft function, rate of complications and patient survival.

Results: Since 2005 191 islet isolations and 46 islet transplantations were performed in 30 recipients. Five patients underwent autotransplantation, 3 received the liver with islets and another 5 patients underwent islet-after-kidney transplantation. 17 patients received pancreatic islets alone, 7 recipients had one islet infusion, 4 recipients had 2 infusions and 6recipients had 3 infusions. In all but 2 subjects the C-peptide levels significantly increased and their daily insulin doses decreased by 50% or more. Only 3 subjects could be completely off insulin. In 5 of 7 recipients with hypoglycaemia unawareness syndrome was successfully treated. We have recorded 4 cases of bleedings, 1 puncture of biliary tract and 1 vasovagal syncope. Two patients required surgery due to bleeding. All other complications resolved spontaneously. Mean (±SD) fasting c-peptide level increased from 0.02±0.02 to 0.2±2ng/ml. Mean daily dose of insulin decreased to about one third of the pretransplant dose. (from 37±11 to 15±7 IU). Mean HbA₁c decreased from 7.6±1.8 to 5.3±0.9%.

Conclusions: In comparison with organ pancreas transplantation, the islet transplantation represents a safe but still less effective method of diabetes treatment. Results might be improved by achieving a higher islet yield and by selection if organs with better quality for islet isolation.

MZO 00023001