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Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: a 5year single centre follow-up

Gerber, P. ; Pavlicek, V. ; Demartines, N. ; Zuellig, R. ; Pfammatter, T. ; Wüthrich, R. ; Weber, M. ; Spinas, G. ; Lehmann, R.

In: Diabetologia, 2008, vol. 51, no. 1, p. 110-119

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    Title
    • Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: a 5year single centre follow-up
    Author
    • Gerber, P.. Department of Endocrinology and Diabetes, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
    • Pavlicek, V.. Department of Endocrinology and Diabetes, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
    • Demartines, N.. Department of Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
    • Zuellig, R.. Department of Endocrinology and Diabetes, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
    • Pfammatter, T.. Department of Radiology, University Hospital Zurich, Zurich, Switzerland
    • Wüthrich, R.. Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
    • Weber, M.. Department of Transplantation Surgery, University Hospital Zurich, Zurich, Switzerland
    • Spinas, G.. Department of Endocrinology and Diabetes, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
    • Lehmann, R.. Department of Endocrinology and Diabetes, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:319294
    Summary
    Aims/hypothesis: The aim of this study was to compare the long-term outcomes—in terms of glucose control, renal function and procedure-related complications—of simultaneous islet-kidney (SIK) transplantation with those of simultaneous pancreas-kidney (SPK) transplantation in patients with type 1 diabetes mellitus. Methods: HbA1c, need for insulin, GFR and complication rate were compared between 13 recipients of SIK and 25 recipients of SPK transplants at the same institution. The mean follow-up was 41months. Results: Two primary organ non-functions occurred in the SIK group. HbA1c did not differ at any time point during follow-up in the SIK group compared with the SPK group (mean during follow-up 6.3 vs 5.9%). Similarly, kidney function over time was not different between the two groups. A higher rate of insulin independence following SPK transplantation (after 1year 96 vs 31% in the SIK group) was counterbalanced by a higher rate of serious adverse events (40% relaparotomies vs 0% in the SIK group). Conclusions/interpretation: The endogenous insulin production achieved by islet transplantation, combined with optimal insulin therapy, was sufficient for maintaining near-normal glucose levels. In terms of glucose control, islet transplantation provides results comparable to those achieved with pancreas transplantation. However, SPK results in a higher rate of insulin independence, albeit at the cost of more surgical complications. These results have led to a new paradigm in islet transplantation at our institution, where the primary goal is not insulin independence, but good glucose control and avoidance of severe hypoglycaemia