Current Diabetes Reports

, Volume 11, Issue 5, pp 413–419 | Cite as

Recurrence of Autoimmunity Following Pancreas Transplantation

  • George W. BurkeIII
  • Francesco Vendrame
  • Antonello Pileggi
  • Gaetano Ciancio
  • Helena Reijonen
  • Alberto Pugliese
Article

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 

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • George W. BurkeIII
    • 1
  • Francesco Vendrame
    • 2
  • Antonello Pileggi
    • 3
  • Gaetano Ciancio
    • 4
  • Helena Reijonen
    • 5
  • Alberto Pugliese
    • 6
  1. 1.Department of Surgery, Division of Transplantation, Leonard Miller School of MedicineUniversity of MiamiMiamiUSA
  2. 2.Diabetes Research Institute, Leonard Miller School of MedicineUniversity of MiamiMiamiUSA
  3. 3.Diabetes Research Institute and Department of SurgeryLeonard Miller School of Medicine, University of MiamiMiamiUSA
  4. 4.Department of Urology, Department of Surgery, Division of Transplantation, Leonard Miller School of MedicineUniversity of MiamiMiamiUSA
  5. 5.Benaroya Research InstituteSeattleUSA
  6. 6.Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Department of MIcrobiology and ImmunologyDiabetes Research Institute, Leonard Miller School of Medicine, University of MiamiMiamiUSA

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