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Hirsch D, Odorico J, Danobeitia JS, Alejandro R, Rickels MR, Hanson M, Radke N, Baidal D, Hullett D, Naji A, Ricordi C, Kaufman D, Fernandez L. Early metabolic markers that anticipate loss of insulin independence in type 1 diabetic islet allograft recipients. Am J Transplant 2012; 12:1275-89. [PMID: 22300172 PMCID: PMC4569145 DOI: 10.1111/j.1600-6143.2011.03947.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The objective of this study was to identify predictors of insulin independence and to establish the best clinical tools to follow patients after pancreatic islet transplantation (PIT). Sequential metabolic responses to intravenous (I.V.) glucose (I.V. glucose tolerance test [IVGTT]), arginine and glucose-potentiated arginine (glucose-potentiated arginine-induced insulin secretion [GPAIS]) were obtained from 30 patients. We determined the correlation between transplanted islet mass and islet engraftment and tested the ability of each assay to predict return to exogenous insulin therapy. We found transplanted islet mass within an average of 16 709 islet equivalents per kg body weight (IEQ/kg BW; range between 6602 and 29 614 IEQ/kg BW) to be a poor predictor of insulin independence at 1 year, having a poor correlation between transplanted islet mass and islet engraftment. Acute insulin response to IVGTT (AIR(GLU) ) and GPAIS (AIR(max) ) were the most accurate methods to determine suboptimal islet mass engraftment. AIR(GLU) performed 3 months after transplant also proved to be a robust early metabolic marker to predict return to insulin therapy and its value was positively correlated with duration of insulin independence. In conclusion, AIR(GLU) is an early metabolic assay capable of anticipating loss of insulin independence at 1 year in T1D patients undergoing PIT and constitutes a valuable, simple and reliable method to follow patients after transplant.
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Affiliation(s)
- D. Hirsch
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - J. Odorico
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - J. S. Danobeitia
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - R. Alejandro
- Department of Medicine, Division of Endocrinology, University of Miami School of Medicine, Miami, FL
| | - M. R. Rickels
- Department of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - M. Hanson
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - N. Radke
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - D. Baidal
- Department of Medicine, Division of Endocrinology, University of Miami School of Medicine, Miami, FL
| | - D. Hullett
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - A. Naji
- Department of Surgery, Division of Transplantation, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - C. Ricordi
- Department of Surgery, Microbiology and Immunology, University of Miami, Miami, FL
| | - D. Kaufman
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI
| | - L. Fernandez
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI,Corresponding author: Luis A. Fernandez,
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Hirsch D, Odorico J, Radke N, Hanson M, Danobeitia JS, Hullett D, Alejandro R, Ricordi C, Fernandez LA. Correction of insulin sensitivity and glucose disposal after pancreatic islet transplantation: preliminary results. Diabetes Obes Metab 2010; 12:994-1003. [PMID: 20880346 PMCID: PMC6419521 DOI: 10.1111/j.1463-1326.2010.01290.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS Pancreatic islet transplantation (PIT) represents a potential curative treatment for patients with type 1 diabetes, but only 10-15% of patients remain insulin independent 5 years post-transplant. It is not known whether intrinsic insulin resistance exacerbated by immunosuppression plays a pivotal role in low graft survival. The study objective was to understand the changes in insulin resistance, glucose effectiveness (S(g)) and free fatty acid dynamics (FFAd) before and after PIT. METHODS Insulin sensitivity index (S(i)), S(g) and FFAd were measured before and after PIT in 10 lean patients, 8 of whom reached insulin independence. Modified Bergman minimal model of frequently sampled intravenous glucose tolerance tests were performed pretransplant and at 12 months post-transplant. Nine non-diabetic control (NDC) subjects matched by age, gender and BMI were used. RESULTS Pretransplant S(i) and S(g) were 3.5 ± 0.8 × 10(-5)/min/(pmol/l) and 0.74 ± 0.24 × 10(-2)/min, respectively. S(i) was significantly lower than matched NDCs [10.8 ± 0.6 × 10(-5)/min/(pmol/l), p < 0.004]; S(g) did not reach statistical significance (1.27 ± 0.22 × 10(-2)/min, p = 0.25). Compared to pretransplant values, mean post-transplant S(i) and S(g) were 9.6 ± 1.3 × 10(-5)/min/(pmol/l)and 1.28 ± 0.22 ×10(-2)/min, respectively, indicating significant improvement for S(i) but not S(g) (p = 0.008 and p = 0.06). Twelve-month post-PIT compared to NDC values were not significantly different (p = 0.58 and 0.97, respectively). In addition, fractional disposal rate for FFA which directly depends on the endogenous insulin release (10-20 min) nearly normalized after PIT (p = 0.06). CONCLUSION These preliminary findings demonstrate that PIT can restore glucose disposal and insulin sensitivity and partially correct glucose effectiveness and FFAd.
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Affiliation(s)
- D Hirsch
- Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI 53792-7375, USA
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Kaddis JS, Danobeitia JS, Niland JC, Stiller T, Fernandez LA. Multicenter analysis of novel and established variables associated with successful human islet isolation outcomes. Am J Transplant 2010; 10:646-56. [PMID: 20055802 PMCID: PMC2860018 DOI: 10.1111/j.1600-6143.2009.02962.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Islet transplantation is a promising therapy used to achieve glycometabolic control in a select subgroup of individuals with type I diabetes. However, features that characterize human islet isolation success prior to transplantation are not standardized and lack validation. We conducted a retrospective analysis of 806 isolation records from 14 pancreas-processing laboratories, considering variables from relevant studies in the last 15 years. The outcome was defined as post-purification islet equivalent count, dichotomized into yields > or =315 000 or < or =220 000. Univariate analysis showed that donor cause of death and use of hormonal medications negatively influenced outcome. Conversely, pancreata from heavier donors and those containing elevated levels of surface fat positively influence outcome, as did heavier pancreata and donors with normal amylase levels. Multivariable logistic regression analysis identified the positive impact on outcome of surgically intact pancreata and donors with normal liver function, and confirmed that younger donors, increased body mass index, shorter cold ischemia times, no administration of fluid/electrolyte medications, absence of organ edema, use of University of Wisconsin preservation solution and a fatty pancreas improves outcome. In conclusion, this multicenter analysis highlights the importance of carefully reviewing all donor, pancreas and processing parameters prior to isolation and transplantation.
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Affiliation(s)
- J S Kaddis
- Administrative and Bioinformatics Coordinating Center, Division of Information Sciences, City of Hope National Medical Center and Beckman Research Institute, Duarte, CA, USA
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