Single-Donor Islet Transplantation and Long-term Insulin Independence in Select Patients With Type 1 Diabetes Mellitus
Single-Donor Islet Transplantation and Long-term Insulin Independence in Select Patients With Type 1 Diabetes Mellitus
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DOI：
10.1097/tp.0000000000000217
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发表时间：
2014-11-15
期刊：
影响因子：
6.2
通讯作者：
Shapiro, A. M. James
中科院分区：
文献类型：
--
作者：
Al-Adra, David P.;Gill, Richdeep S.;Shapiro, A. M. James
背景胰岛移植是公认的I型糖尿病患者的治疗选择。然而，通常需要来自多个捐赠者的胰岛输注才能实现胰岛素独立。理想情况下，只需一名捐赠者就可以常规地实现胰岛素独立。识别与单一供体胰岛移植后胰岛素非依赖性相关的因素可能有助于选择成功率最高的受体-供体组合。方法纳入1999年3月至2013年8月在加拿大埃德蒙顿单一中心接受胰岛移植的受试者。收集受者、供者和移植的特征，并比较胰岛素依赖受者和非受者之间的差异。结果单一供体胰岛移植后31例患者实现胰岛素独立，149例患者未实现胰岛素依赖。两组患者的长期无胰岛素存活率并无差异。与单一供者成功相关的显著因素包括受者年龄、基线时的胰岛素需求量、供者体重、供者体重指数、胰岛移植质量以及移植围术期肝素和胰岛素的应用。在多变量分析中，移植前每日胰岛素需求量、移植围术期肝素和胰岛素输注的使用以及胰岛移植质量仍然显著。结论我们已经确定了定义单一供者移植后实现胰岛素独立的临床相关差异。基于这些差异，术前每日胰岛素需要量小于0.6U/kg和胰岛当量(IEQ)>5646对单一供者胰岛移植后胰岛素依赖的敏感性分别为84%和71%，特异性分别为50%和50%。有了理想的患者选择，这一发现可能会增加单一供者移植的成功率，并可能与预敏受者或随后可能需要肾脏置换的受试者特别相关。
Background Islet transplantation is a recognized treatment option for select patients with type I diabetes mellitus. However, islet infusions from multiple donors are often required to achieve insulin independence. Ideally, insulin independence would be achieved routinely with only a single donor. Identification of factors associated with insulin independence after single-donor islet transplantation may help to select recipient-donor combinations with the highest probability of success.Methods Subjects undergoing islet transplantation at a single center (Edmonton, Canada) between March 1999 and August 2013 were included. Recipient, donor, and transplant characteristics were collected and compared between recipients who became insulin independent after one islet transplantation and those who did not.Results Thirty-one patients achieved insulin independence after a single-donor islet transplantation, and 149 did not. Long-term insulin-free survival was not different between the groups. Factors significantly associated with single-donor success included recipient age, insulin requirement at baseline, donor weight, donor body mass index, islet transplant mass, and peritransplant heparin and insulin administration. On multivariate analysis, pretransplantation daily insulin requirements, the use of peritransplantation heparin and insulin infusions, and islet transplant mass remained significant.Conclusion We have identified clinically relevant differences defining the achievement of insulin independence after single-donor transplantation. Based on these differences, a preoperative insulin requirement of less than 0.6 U/kg per day and receiving more than 5,646 islet equivalents (IEQ)/kg have a sensitivity of 84% and 71% and specificity of 50% and 50%, respectively, for insulin independence after single-donor islet transplantation. With ideal patient selection, this finding could potentially increase single-donor transplantation success and may be especially relevant for presensitized subjects or those who may subsequently require renal replacement.