W.E.M.E. de Vos, R.D. Hauck, M.F. Nijhoff, H.J. van Eyk, M.A. Engelse, E.J.P. de Koning
Cure One T1D Research Center, Leiden University Medical Center, Leiden, the Netherlands
w.e.m.e.de_vos@lumc.nl
Background: Allogeneic islet transplantation (ITx) is performed in patients with severe beta-cell deficiency with or without previous organ transplantation. ITx aims to stabilise glycaemic control by restoring endogenous insulin secretion. Here we report long-term outcomes of a single-centre cohort.
Methods: This retrospective cohort study included islet-after-kidney (IAK), islet-transplantation-alone (ITA), and islet-after-lung (IAL) recipients who underwent 1-3 intraportal islet infusions between 2007-2026. Assessments of graft function and clinical outcomes were performed pre-ITx, at 3 months, and annually thereafter.
Results: We included 112 ITx performed in 74 recipients (38% female; BMI 24.0±3.2 kg/m2; age 52.9±9.2 years; HbA1c 62.5 (IQR 53.4-76.2) mmol/mol Hb; insulin requirement 0.55 (IQR 0.38-0.68) IU/kg/day; diabetes duration 36.4±11.0 years; 44.9% of recipients reported severe hypoglycaemic events (SHEs). Overall, 82.4% of recipients received IAK or IAL. 45.9% of recipients received >1 ITx. Post-ITx assessments for patient survival, graft survival, C-peptide, HbA1c, SHEs and insulin requirement are described in Table 1. Up to 5 years post-ITx, HbA1c and insulin requirement remained lower than baseline (p=0.016 and p=0.002, respectively). Insulin independence was achieved in 23 patients (31.1%) at a median of 11.4 months post-ITx. These recipients received a larger islet mass (21,667 (IQR 15,013-27,088) vs 15,280 (IQR 10,019-22,558) IEQ/kg; p<0.01). Graft failure (persistent fasting C-peptide ≤0.1 nmol/L) occurred in 14.9% (median onset 4.4 years; not explained by total IEQ/kg (p=0.47) or type of ITx (p=0.30)). Liver haemorrhage occurred in 8.9% of infusions (no CTCAE grade 5) and portal vein thrombosis did not occur.
Conclusion: ITx is a minimally invasive procedure that effectively prevents against SHEs, lowers insulin requirement and improves long-term glycaemic control.