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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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.
- ORCID
- Venue
- Diabetologia
- Published
- 2022-10-06
- Volume
- 66
- Issue
- 1
- Pages
- 163-173
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- PMC
- PMC10355148
- 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
- bronze
- doi.org
- Licence
- 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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