Der Diabetologe

, Volume 6, Issue 5, pp 357–365

Insel(zell)-Transplantationen bei Typ-1-Diabetes-Patienten

Leitthema
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Zusammenfassung

Die funktionellen Ergebnisse der Insel(zell)-Transplantation haben sich kontinuierlich verbessert. Eine mögliche Indikation zur Transplantation besteht bei Patienten mit Typ-1-Diabetes (ohne signifikante Insulin-Restsekretion) mit Hypoglykämiesyndrom bzw. schwerst einstellbarem Diabetes (Brittle-Diabetes) oder mit terminaler Niereninsuffizienz und geplanter simultaner Nierentransplantation bzw. bereits vorangegangener Nierentransplantation. Durch eine Insel(zell)-Transplantation kann das primäre Therapieziel einer guten und stabilen Stoffwechseleinstellung unter Vermeidung schwerer Hypoglykämien in der Mehrzahl der Fälle erreicht werden. Nach Registerdaten beträgt das Insel(zell)-Transplantatüberleben ein Jahr nach Transplantation 82%, nach 3 Jahren 75% und die Insulinunabhängigkeitsraten zum Einjahreszeitpunkt 43–50%, nach 3 Jahren 35%. Damit einher geht eine signifikante Verbesserung der Lebensqualität und eine gegenüber alleiniger intensivierter Insulintherapie stärkere Progressionshemmung diabetischer Folgekomplikationen. Patienten mit einem Typ-1-Diabetes mit Transplantationsindikation sollten eine Insel(zell)- oder Pankreastransplantation angeboten und dabei die Vor- und Nachteile beider Therapieverfahren sorgfältig individuell abgewogen werden.

Schlüsselwörter

Typ-1-Diabetes Insel(zell)-Isolation Insel(zell)-Transplantation Insulinunabhängigkeit Immunsuppression 

Islet (cell) transplantation in type-1 diabetes patients

Abstract

Functional results of islet (cell) transplantation have continuously improved over time. One potential indication for islet (cell) transplantation is given in type-1 diabetic recipients without significant endogenous insulin secretion and frequent severe hypoglycemic episodes (ITA), as well as with end-stage nephropathy (SIK) or previous kidney transplantation (IAK). Islet (cell) transplantation achieves the primary therapy goal of graft function and stable glucose control without severe hypoglycemia in the majority of cases. According to registry data, islet (cell) graft survival after 1 and 3 years is 82% and 75%, and insulin independence 43%–50% and 35%, respectively. This is associated with a significant improvement in quality of life and reduced progression of secondary diabetic complications compared with intensified insulin therapy alone. Patients with type-1 diabetes mellitus and the indication for transplantation should be offered either islet (cell) or vascularized pancreas transplantation while taking the benefits and risks of each treatment option into consideration.

Keywords

Type-1 diabetes mellitus Islet (cell) isolation Islet (cell) transplantation Insulin independence Immunosuppression 

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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • M.D. Brendel
    • 1
  • B. Ludwig
    • 1
  • M. Eckhard
    • 2
  • R.G. Bretzel
    • 2
  1. 1.Medizinische Klinik und Poliklinik III, Insel(zell)-TransplantationUniversitätsklinikum Carl-Gustav-Carus, Technische Universität DresdenDresdenDeutschland
  2. 2.Medizinische Klinik und Poliklinik IIIUniversitätsklinikum Gießen und Marburg, Standort Gießen, Justus-Liebig-Universität GießenGießenDeutschland

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