Primary Graft Function and 5 Year Insulin Independence After Pancreas and Islet Transplantation for Type 1 Diabetes: A Retrospective Parallel Cohort Study

Transpl Int. 2023 Dec 28:36:11950. doi: 10.3389/ti.2023.11950. eCollection 2023.

Abstract

In islet transplantation (ITx), primary graft function (PGF) or beta cell function measured early after last infusion is closely associated with long term clinical outcomes. We investigated the association between PGF and 5 year insulin independence rate in ITx and pancreas transplantation (PTx) recipients. This retrospective multicenter study included type 1 diabetes patients who underwent ITx in Lille and PTx in Nantes from 2000 to 2022. PGF was assessed using the validated Beta2-score and compared to normoglycemic control subjects. Subsequently, the 5 year insulin independence rates, as predicted by a validated PGF-based model, were compared to the actual rates observed in ITx and PTx patients. The study enrolled 39 ITx (23 ITA, 16 IAK), 209 PTx recipients (23 PTA, 14 PAK, 172 SPK), and 56 normoglycemic controls. Mean[SD] PGF was lower after ITx (ITA 22.3[5.2], IAK 24.8[6.4], than after PTx (PTA 38.9[15.3], PAK 36.8[9.0], SPK 38.7[10.5]), and lower than mean beta-cell function measured in normoglycemic control: 36.6[4.3]. The insulin independence rates observed at 5 years after PTA and PAK aligned with PGF predictions, and was higher after SPK. Our results indicate a similar relation between PGF and 5 year insulin independence in ITx and solitary PTx, shedding new light on long-term transplantation outcomes.

Keywords: insulin independence; islet transplant; pancreas allograft; prediction; primary graft function.

Publication types

  • Multicenter Study

MeSH terms

  • Cohort Studies
  • Diabetes Mellitus, Type 1* / surgery
  • Graft Survival
  • Humans
  • Insulin / therapeutic use
  • Islets of Langerhans Transplantation*
  • Pancreas
  • Pancreas Transplantation* / methods
  • Retrospective Studies

Substances

  • Insulin

Grants and funding

INSERM U1190 was supported by grants from Agence National de la Recherche (European Genomic Institute for Diabetes, ANR-10-LABX-46), Fondation de l’Avenir, Fonds de Dotation Line Renaud–Loulou Gasté, I-Site ULNE. CM received grants from the French national Agency of Biomedicine, the French Society of diabetes and the Fondation pour la Recherche Médicale for research projects dealing with pancreas transplantation.