Successful pregnancy and delivery after simultaneous islet-kidney transplantation
Successful pregnancy and delivery after simultaneous islet-kidney transplantation
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DOI：
10.1111/ajt.14884
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发表时间：
2018-08-01
影响因子：
8.8
通讯作者：
Berney, Thierry
中科院分区：
文献类型：
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作者：
Assalino, Michela;Podetta, Michele;Berney, Thierry
朗格汉斯同种异体胰岛移植是公认的 1 型糖尿病患者的 β 细胞替代疗法。 1 型糖尿病是一种与孕妇和胎儿不良后果风险增加相关的疾病。我们报告了一名患有 1 型糖尿病的 29 岁女性的病例，她成功接受了同种异体胰岛移植，同时进行了肾移植。在两次胰岛输注后，她实现了持久的胰岛素独立。最后一次胰岛输注后 2 年后希望并计划怀孕。对妊娠进行多学科监测并调整免疫抑制方案。整个怀孕期间无需外源胰岛素即可维持正常血糖。在一次平安的怀孕后，她足月生下了一个原本健康的男婴，但肛门闭锁，并立即进行了手术矫正。总之，同种异体胰岛移植是一种适合患有复杂 1 型糖尿病的育龄妇女的治疗方法，可以在妊娠期间实现生理血糖控制，并且移植物丢失的风险较低。这一目标只有通过严格的多学科随访才能实现，包括免疫抑制治疗的适应以及充分的糖尿病和产科监测。同时接受胰岛肾移植的患者在没有外源胰岛素的情况下维持正常血糖，妊娠顺利。
Allogeneic islet of Langerhans transplantation is a recognized beta-cell replacement therapy for patients affected by type 1 diabetes mellitus. Type 1 diabetes mellitus is a condition associated with an increased risk of adverse outcomes for pregnant women and fetuses. We report the case of a 29-year-old woman with type 1 diabetes mellitus, who underwent successful allogeneic islet transplantation with simultaneous kidney transplantation. She achieved durable insulin independence after 2 islet infusions. Pregnancy was desired and planned 2years after the last islet infusion. Multidisciplinary monitoring of pregnancy was carried out and the immunosuppressive regimen was adapted. Euglycemia was maintained throughout pregnancy without the need for exogenous insulin. After an uneventful pregnancy, she delivered on term an otherwise healthy male child with imperforate anus that was immediately surgically corrected. In conclusion, allogeneic islet transplantation is a suitable treatment for women of childbearing age with complicated type 1 diabetes mellitus, allowing physiologic glycemic control during pregnancy with a low risk of graft loss. This target can be achieved only by a tight multidisciplinary follow-up, including immunosuppressive therapy adaptation and adequate diabetes and obstetrical monitoring.A patient who underwent a simultaneous islet-kidney transplant has an uneventful pregnancy while maintaining euglycemia without exogenous insulin.