The IKEM Pancreas and Islet Transplant Program as Part of Healthcare for Type 1 Diabetes Patients: Retrospective Analysis of Outcome from 1983 to 2010

Abstract

■ AbstractCurrently, 25-30 pancreas transplantations per year are carried out in type 1 diabetes (T1D) recipients residing in Czech Republic. Most of the recipients are transplanted together with kidney allografts, but pancreas is also transplanted alone in selected patients with brittle diabetes. Since 2005, the Institute for Clinical and Experimental Medicine (IKEM) islet transplant program was initiated as complementary therapeutic modality. The aim of this paper was to analyze the transplant program at our clinical center, and to examine the survival of recipients, and their pancreas, kidney, and islet grafts. Patient and graft survival rates were evaluated in the following three categories using KaplanMeier test: simultaneous pancreas and kidney transplantation (SPKTx), pancreas transplantation alone (PTA), and islet transplantation (ITx). Three hundred and ninety SPKTx, 34 PTA and 44 ITx were carried out between 1983 and 2010. One-and 5-year patient survival rates were 92 % and 81% in SPKTx, respectively. In SPKTx, the 1-year survival rate of pancreas grafts was 78%, and the 5-year rate was 66%. Kidney graft survival rates were 89% and 79%, respectively, after the same follow-up periods. In the PTA category, recipient survivals were 100% after 1 year, and 92% after 3 years. 70% and 65% of pancreatic grafts were working properly at 1 and 3-year follow-ups, respectively. To date, we have carried out 44 islet transplantations in 31 recipients. Islet function (C-peptide ≥ 0.2 ng/ml) was documented in 60% of recipients after 12 months. So far, only 3 patients remained free of exogenous insulin. While SPKTx is a well established treatment for uremic T1D patients, ITx represents an emerging complementary treatment modality. The latter is especially suitable for high-risk recipients, but routine clinical application is still hampered by the limited availability of usable organ transplants and viability of transplanted islets.

Benefits of Islet Transplantation as an Alternative to Pancreas Transplantation: Retrospective Study of More Than 10 Ten Years of Experience in a Single Center

“…tive treatment option in intractable hypoglycemia unawareness syndrome. It must be noted that this attempt was made in a center with extensive experience and excellent results in pancreas transplantation [17]. The study reflects the difficulties to be overcome at the beginning of a program before pancreatic islet transplantation becomes an effective and safe treatment of hypoglycemia unawareness syndrome to attain stabilization of glucose metabolism in properly selected patients.…”

“…Ongoing intention-to-treat immunosuppression consisted of tacrolimus with mycophenolate mophetil and tapered doses of corticosteroids within the first 6 weeks. The immunosuppressive regimen used before 2004 and the surgical procedures are described in detail by Girman and colleagues [17]. Pancreas donor medium age was 36 (29-38.5) years and BMI 23 (20)(21)(22)(23)(24)(25)(26)(27) kg/m 2 .…”

Experimental transplantation of newborn piglet pancreatic microfragments after culturing or hypothermal storage in HTK solution

“…В первые недели жизни наблюдается интенсивный прирост β-клеточной массы в ПЖ за счет дифференцировки из клеток-предшественников, пролиферации β-клеток и увеличения их размеров [10]. Островки ПЖ новорожденных поросят содержат значительное количество клеток-предшественников, которые могут дифференцироваться в зрелые клетки островков [12,29,33]. G.S.…”

Medicinal Plants of Trinidad and Tobago: Selection of Antidiabetic Remedies

“…Other therapies for Type I DM have included whole organ (pancreas) transplants since 1966 or more recently pancreatic islet transplants (Girman andSaudek 2011 andQi 2014).…”