Acta Diabetologica

, Volume 28, Issue 2, pp 151–157 | Cite as

Fresh human islet transplantation to replace pancreatic endocrine function in type 1 diabetic patients

Report of six cases
  • C. Socci
  • L. Falqui
  • A. M. Davalli
  • C. Ricordi
  • S. Braghi
  • F. Bertuzzi
  • P. Maffi
  • A. Secchi
  • F. Gavazzi
  • M. Freschi
  • P. Magistretti
  • S. Socci
  • A. Vignali
  • V. Di Carlo
  • G. Pozza

Abstract

The aim of this study was to evaluate the feasibility of islet allografts in patients with type 1 diabetes melititus. Six patients received human islets from either one or two donors via the portal vein, after (n=4) or simultaneously with (n=2) a kidney graft. The patients with functioning kidney grafts (nos. 1–4) were already on triple immunosuppressive therapy (cyclosporine A, azathioprine, prednisone). Prednisone was increased to 60 mg/day for 15 days after the islet transplant in patient 1. Patient 2–4 and the patients who underwent a simultaneous kidney-islets graft (nos. 5, 6) also received antilymphocyte globulin. Intravenous insulin was given for the first 15 days to maintain blood glucose concentrations within the normal range. Patient 1 rejected the islets within 15 days of islet transplantation. In patient 2, a 25% reduction in insulin requirement was observed and 12 months after transplantation post-prandial serum C-peptide was 1.5 ng/ml. In patient 3, the insulin requirement decreased from 40 to 8 units/day with a post-prandial serum C-peptide of 4.1 ng/ml 12 months after islet transplantation. In patient 4 the post-prandial secretion of C-peptide increased to 6.4 ng/ml. Six months after the islet infusion, insulin therapy was discontinued and HbA1c, 24-h metabolic profile and oral glucose tolerance test remained within the normal range. He had remained off insulin for 5 months until recently, when foot gangrene paralleled a worsening of post-prandial glycaemic control. Twelve months after transplantation he is receiving 8 units insulin/day. Patients 5 and 6 received a simultaneous kidney and islet graft and 6 months after transplantation their post-prandial C-peptide secretion peaks were 2.5 and 1.9 ng/ml respectively. Their daily insulin requirement was not significantly modified. In conclusion, these results show that an adequate number of human islets injected intraportally in type 1 diabetic patients can replace the pancreatic endocrine function and can lead to insulin independence.

Key words

Islet allograft Type 1 insulin-dependent diabetes mellitus Human 

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Copyright information

© Springer-Verlag 1991

Authors and Affiliations

  • C. Socci
    • 1
  • L. Falqui
    • 2
  • A. M. Davalli
    • 2
  • C. Ricordi
    • 1
  • S. Braghi
    • 2
  • F. Bertuzzi
    • 2
  • P. Maffi
    • 2
  • A. Secchi
    • 2
  • F. Gavazzi
    • 1
  • M. Freschi
    • 3
  • P. Magistretti
    • 1
  • S. Socci
    • 1
  • A. Vignali
    • 2
  • V. Di Carlo
    • 1
  • G. Pozza
    • 2
  1. 1.Department of Surgery, Scientific Institute San RaffaeleUniversity of MilanMilanItaly
  2. 2.Department of Medicine, Scientific Institute San RaffaeleUniversity of MilanMilanItaly
  3. 3.Department of Pathology, Scientific Institute San RaffaeleUniversity of MilanMilanItaly
  4. 4.Chirurgia IIScientific Institute San RaffaeleMilanItaly

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