The impact of islet mass, number of transplants, and time between transplants on graft function in a national islet transplant program.
The impact of islet mass, number of transplants, and time between transplants on graft function in a national islet transplant program.
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DOI：
10.1111/ajt.16785
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发表时间：
2022-01
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英国胰岛同种异体移植计划由国家资助，在12个月内为1型糖尿病和复发性严重低血糖患者提供一到两次移植。在项目开始后10年进行分析，以评估移植质量之间的相关性;单次与两次移植;两次移植之间的时间和移植物存活率（刺激的C肽>50 pmol/L）和功能。总共研究了84名胰岛移植受者。23例（68%）单次移植受者和47例（94%）（p = 0.002）两次移植受者（间隔[中位数（IQR）] 6（3-8）个月）获得了超过12个月的不间断移植物存活。64%的接受者在12个月时接受了一次或两次移植，功能不受影响，6年时移植物功能持续。总移植质量与12个月时混合膳食耐受性试验刺激的C肽相关（p < .01）。尽管两个胰岛输注的受体的移植质量比一个胰岛输注的受体大1.9倍（12 218 [9291-15 417] vs. 6442 [5156-7639] IEQ/kg; p < .0001），但刺激的C肽并不显著更高。移植间隔时间越短，12个月时胰岛素剂量减少越多（β-0.35; p = .02）。在英国计划中，两个胰岛移植的受者在前12个月的移植物存活率高于一个胰岛移植的受者，尽管1年和6年的功能相当。最小化2次胰岛输注之间的间隔可以最大化对移植物功能的累积影响。来自英国胰岛移植联盟的数据表明，2例与1例胰岛同种异体移植受者的1年移植物功能和6年移植物存活率相当，但当第2次移植超过第1次移植后6个月时，移植物结局减弱，导致分配政策发生变化，以促进第1次移植后3个月内的第2次移植。
The UK islet allotransplant program is nationally funded to deliver one or two transplants over 12 months to individuals with type 1 diabetes and recurrent severe hypoglycemia. Analyses were undertaken 10 years after program inception to evaluate associations between transplanted mass; single versus two transplants; time between two transplants and graft survival (stimulated C‐peptide >50 pmol/L) and function. In total, 84 islet transplant recipients were studied. Uninterrupted graft survival over 12 months was attained in 23 (68%) single and 47 (94%) (p = .002) two transplant recipients (separated by [median (IQR)] 6 (3–8) months). 64% recipients of one or two transplants with uninterrupted function at 12 months sustained graft function at 6 years. Total transplanted mass was associated with Mixed Meal Tolerance Test stimulated C‐peptide at 12 months (p < .01). Despite 1.9‐fold greater transplanted mass in recipients of two versus one islet infusion (12 218 [9291–15 417] vs. 6442 [5156–7639] IEQ/kg; p < .0001), stimulated C‐peptide was not significantly higher. Shorter time between transplants was associated with greater insulin dose reduction at 12 months (beta −0.35; p = .02). Graft survival over the first 12 months was greater in recipients of two versus one islet transplant in the UK program, although function at 1 and 6 years was comparable. Minimizing the interval between 2 islet infusions may maximize cumulative impact on graft function. Data from the UK Islet Transplant Consortium demonstrate comparable 1‐year graft function and 6‐year graft survival in recipients of 2 versus 1 islet allotransplant but attenuated graft outcomes when the 2nd transplant is more than 6 months after the 1st, leading to allocation policy changes to facilitate a 2nd allotransplant within 3 months of the 1st.
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影响因子：
16.2
作者：
Vantyghem, Marie-Christine;Chetboun, Mikael;Pattou, Francois
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5.8
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8.8
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Brooks, A. M.;Walker, N.;Shaw, J. A. M.
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16.2
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