Insulin-heparin infusions peritransplant substantially improve single-donor clinical islet transplant success.

Abstract:

BACKGROUND:Successful islet transplantation can result in insulin independence in many patients with type 1 diabetes mellitus, but it often requires more than one islet infusion. The ability to achieve insulin independence with a single donor is an important goal in clinical islet transplantation due to the limited organ supply. METHODS:We examined factors that may be associated with insulin independence after islet transplantation with islets from a single donor, using univariate and multivariate analysis. RESULTS:Thirteen of 85 (15.3%) achieved insulin independence after single-donor islet transplantation. Using multivariate analysis, only the use of insulin and heparin infusions peritransplant was a significant factor associated with insulin independence, with an adjusted odds ratio of 8.6 (95% confidence interval 2.0-37.0). Patients who had received insulin and heparin infusions peritransplant had greater indices of islet engraftment and a greater reduction in insulin use (80.1% + or - 4.3% vs. 54.2% + or - 2.8%, P<0.001) even if insulin independence was not achieved. CONCLUSIONS:Peritransplant intensive insulin and heparin enhances islet transplantation outcomes likely related in part to mitigation of the effects of the instant blood-mediated inflammatory reaction, combined with islet rest and avoidance of inflammation. It would be important to further investigate the effects of peritransplant insulin and heparin infusions on islet engraftment.

journal_name

Transplantation

journal_title

Transplantation

authors

Koh A,Senior P,Salam A,Kin T,Imes S,Dinyari P,Malcolm A,Toso C,Nilsson B,Korsgren O,Shapiro AM

doi

10.1097/TP.0b013e3181c478fd

subject

Has Abstract

pub_date

2010-02-27 00:00:00

pages

465-71

issue

4

eissn

0041-1337

issn

1534-6080

pii

00007890-201002270-00015

journal_volume

89

pub_type

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