Current Diabetes Reports

, Volume 11, Issue 5, pp 413–419

Recurrence of Autoimmunity Following Pancreas Transplantation

Authors

  • George W. BurkeIII
    • Department of Surgery, Division of Transplantation, Leonard Miller School of MedicineUniversity of Miami
  • Francesco Vendrame
    • Diabetes Research Institute, Leonard Miller School of MedicineUniversity of Miami
  • Antonello Pileggi
    • Diabetes Research Institute and Department of SurgeryLeonard Miller School of Medicine, University of Miami
  • Gaetano Ciancio
    • Department of Urology, Department of Surgery, Division of Transplantation, Leonard Miller School of MedicineUniversity of Miami
  • Helena Reijonen
    • Benaroya Research Institute
    • Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of MIcrobiology and ImmunologyDiabetes Research Institute, Leonard Miller School of Medicine, University of Miami
Article

DOI: 10.1007/s11892-011-0206-y

Cite this article as:
Burke, G.W., Vendrame, F., Pileggi, A. et al. Curr Diab Rep (2011) 11: 413. doi:10.1007/s11892-011-0206-y

Abstract

Pancreas transplantation is a therapeutic option for patients with type 1 diabetes. Advances in immunosuppression have reduced immunologic failures, and these are usually categorized as chronic rejection. Yet studies in our cohort of pancreas transplant recipients identified several patients in whom chronic islet autoimmunity led to recurrent diabetes, despite immunosuppression that prevented rejection. Recurrent diabetes in our cohort is as frequent as chronic rejection, and thus is a significant cause of immunologic graft failure. Our studies demonstrated islet autoimmunity by the presence of autoantibodies and autoreactive T cells, which mediated ß-cell destruction in a transplantation model. Biopsy of the transplanted pancreas revealed variable degrees of ß-cell loss, with or without insulitis, in the absence of pancreas and kidney transplant rejection. Additional research is needed to better understand recurrent disease and to identify new treatment regimens that can suppress autoimmunity, as in our experience this is not effectively inhibited by conventional immunosuppression.

Keywords

Type 1 diabetes Pancreas transplantation Recurrent diabetes Autoimmunity GAD65 Autoantibodies

Copyright information

© Springer Science+Business Media, LLC 2011