Islet transplantation is an experimental therapy for selected patients with type 1-diabetes (T1DM). It remains limited by immunosuppressive drug toxicity, progressive loss of insulin independence, allosensitization, and the need for multiple islet donors. We describe our experience with an efalizumab-based immunosuppressive regimen as compared to the prevailing standard regimen, the Edmonton protocol. Twelve patients with T1DM received islet transplants: 8 were treated with the Edmonton protocol; 4 were treated with daclizumab induction, a 6-month course of tacrolimus, and maintenance with efalizumab and mycophenolate mofetil. The primary endpoint was insulin independence after one islet infusion. Only 2 Edmonton protocol treated patients achieved the primary endpoint; 6 required islets from multiple donors, and all experienced leukopenia, mouth ulcers, anemia, diarrhea, and hypertransaminasemia. Four became allosensitized. All patients treated with the efalizumab-based regimen achieved insulin independence with normal hemoglobin A1c after a single islet cell infusion and remained insulin independent while on efalizumab. These patients experienced significantly fewer side effects and none became allosensitized. Trial continuation was terminated by withdrawal of efalizumab from the market. These data suggest that this efalizumab-based regimen prevents islet rejection, is well tolerated, and allows for single donor islet transplantation.

The principle risk factors for suicide attempts in adolescents discussed in the literature are examined on the basis of data from a study carried out at the Geneva University Hospitals. 148 adolescents aged between 15 and 19 years form the sample. The results concerning mental disorders at the time of the suicide attempt confirm the clear predominance of affective disorder as well as the elevated frequency of comorbidity. Other main risk factors include suicidal behavior in family members and among acquaintances, poor state of health, poor integration into school or professional life, as well as sexual abuse.

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