Cited by 51Pancreatic function and diabetesDiabetes and associated disordersDiabetes Management and Research

Factors associated with favourable 5 year outcomes in islet transplant alone recipients with type 1 diabetes complicated by severe hypoglycaemia in the Collaborative Islet Transplant Registry

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Hering, Bernhard J., Ballou, Cassandra M., Bellin, Melena D., Payne, Elizabeth H., Kandeel, Fouad, Witkowski, Piotr, Alejandro, Rodolfo, Rickels, Michael R. +1 more·2023·Diabetologia

Abstract

Aims/hypothesis Islet transplantation has been studied in small cohorts of recipients with type 1 diabetes complicated by severe hypoglycaemic events (SHEs). We determined factors associated with favourable outcomes in a large cohort of recipients reported to the Collaborative Islet Transplant Registry (CITR). Methods In 398 non-uraemic islet transplant alone (ITA) recipients with type 1 diabetes and SHEs, transplanted between 1999 and 2015 and with at least 1 year follow-up, we analysed specified favourable outcomes against each of all available characteristics of pancreas donors, islet grafts, recipients and immunosuppressive regimens, as well as immunosuppression and procedure-related serious adverse events (SAEs). Results Four factors were associated with the highest rates of favourable outcomes: recipient age ≥35 years; total infused islets ≥325,000 islet equivalents; induction immunosuppression with T cell depletion and/or TNF-α inhibition; and maintenance with both mechanistic target of rapamycin (mTOR) and calcineurin inhibitors. At 5 years after the last islet infusion, of the recipients meeting these four common favourable factors (4CFF; N=126), 95% were free of SHEs, 76% had HbA 1c <53 mmol/mol (7.0%), 73% had HbA 1c <53 mmol/mol (7.0%) and absence of SHEs, and 53% were insulin independent, significantly higher rates than in the remaining recipients (<4CFF; N=272). The incidence of procedural and immunosuppression-related SAEs per recipient that resulted in sequelae, disability or death was low in both the 4CFF (0.056 per person) and <4CFF (0.074 per person) groups. Conclusions/interpretation In recipients with type 1 diabetes complicated by SHEs, islet transplantation meeting 4CFF protected 95% from SHEs at 5 years after the last islet infusion and exerted a large and significant benefit on glycaemic control, with an acceptable safety profile for this subgroup of type 1 diabetes.

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  • Graft success increases when a high number of islets are transplanted, often resulting in the need for multiple donor pancreases.

    “In particular, graft success increases when a high number of islets are transplanted, often resulting in the need for multiple donor pancreases. 15,20,24”

    From Developments in stem cell-derived islet replacement therapy for treating type 1 diabetes (2023) · cites this paper as [24]

    The Results (‘The common favourable factors’; page unavailable) associate at least 325,000 infused islet equivalents with more favourable outcomes in the studied recipients. The Introduction says 74% received at least two islet infusions, but does not establish that achieving a high islet dose often requires multiple donor pancreases; the observational association also does not establish causation. (LLM, conf=0.86)

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Authors
Hering, B. J., Ballou, C. M., Bellin, M. D., Payne, E. H., Kandeel, F., Witkowski, P., Alejandro, R., Rickels, M. R., & Barton, F. B.
Affiliations
  • University of Minnesota (US)
  • Emmes (United States) (US)
  • City Of Hope National Medical Center (US)
  • University of Chicago (US)
  • University of Miami (US)
  • University of Pennsylvania (US)
Corresponding author
  • Hering, Bernhard J.
  • Ballou, Cassandra M.
Venue
Diabetologia
Published
2022-10-06
Volume
66
Issue
1
Pages
163-173
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
OpenAlex
W4302288336
Cited by
51
References
34
Citations by year
2026: 6 · 2025: 19 · 2024: 13 · 2023: 11 · 2022: 2
FWCI
10.75
Type
journal article
Language
en
Open access
Locations
  • Diabetologia (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Eli Lilly and Company
  • University of Miami
  • University of Pennsylvania
  • Emory University
  • Northwestern University
  • University of Minnesota
  • Vertex Pharmaceuticals
  • Insulet Corporation
  • Dexcom
  • University of Alberta
  • Hôpitaux Universitaires de Genève
  • Centre hospitalier régional universitaire de Lille
  • National Institutes of Health (5r01dk091331-10)
  • University of Illinois at Urbana-Champaign
  • Weill Cornell Medical College
  • University of California, San Francisco
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01-DK-091331, UC4DK114839, UC4DK098086, U01DK133709, P30DK020595)
Topics
  • Health Sciences › Medicine › Surgery › Pancreatic function and diabetes
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
islet transplantation, type 1 diabetes, severe hypoglycemia, T cell depletion, anti-TNF therapy, mTOR inhibitors, calcineurin inhibitors, immunosuppression, glycemic control, insulin independence, serious adverse events
MeSH terms
Adult, Diabetes Mellitus, Type 1, Humans, Islets of Langerhans Transplantation

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