Serological markers of recurrent beta cell destruction in diabetic patients undergoing pancreatic transplantation

Transplantation. 2000 Jan 15;69(1):99-103. doi: 10.1097/00007890-200001150-00018.


Background: Besides alloimmunity to transplanted pancreatic tissue, recurrent autoimmune beta cell destruction is an additional limitation to successful clinical pancreatic allografts in type 1 diabetic patients.

Methods: We studied the prevalence of autoantibodies to glutamate decarboxylase (GAD) 65 and tyrosine phosphatase (IA-2) in 68 C-peptide-negative diabetic patients receiving pancreatic allografts. Sera from patients were obtained immediately before grafting. A second blood sample was analyzed at the time of graft failure in patients who returned to hyperglycemia and during the same follow-up period in those who experienced a functional pancreatic allograft. Patients were classified according to clinical outcome into chronic graft failure (group A, n=20), acute graft failure and/or arterial thrombosis (n=7), or functional pancreatic graft (group C, n=41). Sera from patients were screened for the presence of specific autoantibodies using an islet cell autoantibody assay, a combi-GAD and IA-2 test, and individual GAD and IA-2 assays.

Results: Patients from group A had significantly higher combi-test values than patients from group C (13+/-16 vs. 4.5+/-12 units, P<0.02) and higher anti-GAD65 antibody (Ab) levels (0.19+/-0.3 vs. 0.04+/-0.13 units, P<0.01) immediately before grafting. After graft failure in group A, both anti-GAD65 and anti-IA-2 Ab levels increased from baseline, but only the increase in anti-IA-2 Ab levels reached statistical significance (0.28+/-0.12 vs. 15+/-34, P=0.03). When compared with group C, patients from group A had higher anti-GAD65 Abs (0.29+/-0.35 vs. 0.05+/-0.16, P<0.001) after graft failure. Interestingly, the number of double-Ab-positive patients rose from 5% to 35% in group A, whereas it remained at 5% in group C. In pancreatic transplants with bladder drainage, the presence of anti-GAD65 and/or anti-IA2 Abs was not associated with a reduction in urinary amylase levels. This suggests that a loss of endocrine function was not associated with exocrine failure in patients from group A.

Conclusions: We can conclude from the present study that peripheral autoimmune markers are useful in diabetic patients receiving pancreatic allografts.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Amylases / urine
  • Autoantibodies / analysis*
  • Biomarkers / analysis
  • C-Peptide / deficiency
  • Diabetes Mellitus, Type 1 / pathology*
  • Diabetes Mellitus, Type 1 / surgery*
  • Diabetes Mellitus, Type 1 / urine
  • Female
  • Glutamate Decarboxylase / immunology
  • Humans
  • Islets of Langerhans / pathology*
  • Isoenzymes / immunology
  • Male
  • Middle Aged
  • Pancreas / physiopathology
  • Pancreas Transplantation / immunology*
  • Protein Tyrosine Phosphatase, Non-Receptor Type 1
  • Protein Tyrosine Phosphatases / immunology
  • Recurrence
  • Treatment Failure
  • Treatment Outcome


  • Autoantibodies
  • Biomarkers
  • C-Peptide
  • Isoenzymes
  • Protein Tyrosine Phosphatase, Non-Receptor Type 1
  • Protein Tyrosine Phosphatases
  • Amylases
  • Glutamate Decarboxylase
  • glutamate decarboxylase 2