P-178

Challenges in patient screening and selection for successful pancreatic islets transplantation

R. Misawa, J.R. Thislethwaite, S. Dronavalli, K. Singraber L.H. Philipson, O. Cochet, L. Wang, X. Wang, A. Krzystyniak, K. Golab, Y. Becker, J.M. Millis, P. Witkowski
University of Chicago, Surgery, Chicago, USA

Objective: The aim of the study was to assess the burden of the patient screening and selection process, reasons for drop out and assessment of the success rate in pancreatic islet transplantation for brittle type 1 diabetics.

Methods: Screening questionnaires were distributed to potential islets transplant candidates upon their request. For individuals who met inclusion criteria, primary care physicians were asked for referrals and medical compliance histories. Pancreatic islets were administered sequentially in up to 3 separate infusions with the goal of insulin independence. The initial immunosuppression protocol consisted of IL-2 receptor antibody,rapamycin and tacrolimus.

Results: Detailed results of patient screening and selection are presented on the Figure. During the screening process patient were excluded mainly due to BMI>28, need for optimization of insulin therapy optimization, CrCl<80, age>60, previous transplant, and increased risk of noncompliance base on opinion of referring physician. After initial screening, from 41 patients who signed the consent for participation and further evaluation only 9 (22%) individuals successfully accomplished selection process and were transplanted. However, only 4 patients completed the goal of the study- received up to three islets infusion or achieved insulin independence. All of them remained insulin free for 5, 3, 2 and 1 years after the last infusion without hypoglycemic unawareness. All metabolic measurements like MAGE, Beta score and HbA1C improved. None of the patients developed elevated serum creatinine, proteinuria or positive PRAs post-transplant. Despite side effects of the immunosuppressive therapy all patients emphasized enormous improvement in their quality of life.

Conclusions: Only a small fraction of patients presenting for evaluation are suitable candidates for islets transplantation. Additionally, despite thorough patient screening and selection, substantial drop out rate due to noncompliance remains a significant challenge of the procedure. Nevertheless, pancreatic islet transplantation offered excellent glycemic control in properly selected brittle type 1 diabetics.

P-178

Challenges in patient screening and selection for successful pancreatic islets transplantation

R. Misawa, J.R. Thislethwaite, S. Dronavalli, K. Singraber L.H. Philipson, O. Cochet, L. Wang, X. Wang, A. Krzystyniak, K. Golab, Y. Becker, J.M. Millis, P. Witkowski
University of Chicago, Surgery, Chicago, USA

Objective: The aim of the study was to assess the burden of the patient screening and selection process, reasons for drop out and assessment of the success rate in pancreatic islet transplantation for brittle type 1 diabetics.

Methods: Screening questionnaires were distributed to potential islets transplant candidates upon their request. For individuals who met inclusion criteria, primary care physicians were asked for referrals and medical compliance histories. Pancreatic islets were administered sequentially in up to 3 separate infusions with the goal of insulin independence. The initial immunosuppression protocol consisted of IL-2 receptor antibody,rapamycin and tacrolimus.

Results: Detailed results of patient screening and selection are presented on the Figure. During the screening process patient were excluded mainly due to BMI>28, need for optimization of insulin therapy optimization, CrCl<80, age>60, previous transplant, and increased risk of noncompliance base on opinion of referring physician. After initial screening, from 41 patients who signed the consent for participation and further evaluation only 9 (22%) individuals successfully accomplished selection process and were transplanted. However, only 4 patients completed the goal of the study- received up to three islets infusion or achieved insulin independence. All of them remained insulin free for 5, 3, 2 and 1 years after the last infusion without hypoglycemic unawareness. All metabolic measurements like MAGE, Beta score and HbA1C improved. None of the patients developed elevated serum creatinine, proteinuria or positive PRAs post-transplant. Despite side effects of the immunosuppressive therapy all patients emphasized enormous improvement in their quality of life.

Conclusions: Only a small fraction of patients presenting for evaluation are suitable candidates for islets transplantation. Additionally, despite thorough patient screening and selection, substantial drop out rate due to noncompliance remains a significant challenge of the procedure. Nevertheless, pancreatic islet transplantation offered excellent glycemic control in properly selected brittle type 1 diabetics.