Type 1 Diabetes Recurrence After Simultaneous Pancreas-Kidney Transplantation
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Purpose of Review
Simultaneous pancreas-kidney transplantation (SPKT) is an important option for patients with type 1 diabetes (T1D) and end-stage renal disease. While most SPKT recipients experience long-term euglycemia, about 5% return to insulin therapy, 5–20 years after transplantation due to T1D recurrence (T1DR). Over the last two decades, we have assessed autoimmunity in our patients, evaluating autoantibodies (GAD65, IA2, and ZnT8), autoreactive T cells, and pancreas transplant biopsies.
Most patients demonstrate seroconversion for multiple autoantibodies. Autoreactive memory T cells have been identified in the peripheral blood, pancreas transplant, and peri-pancreas transplant tissues. Biopsies generally exhibit insulitis, the typical lesion of T1D, affecting pancreatic islets in the pancreas transplant, and lack of rejection in the pancreas and kidney transplants.
In addition to membrane expression of memory markers, we have identified other biomarkers, including CXCR3, on circulating and infiltrating autoreactive memory T cells. We hope that this work will lead to therapeutic intervention in our patients with T1DR, and that this will translate to effective treatment for T1D.
KeywordsPancreas transplant Type 1 diabetes Autoimmunity Autoantibodies Autoreactive T cells Memory T cells
The authors wish to acknowledge the John C. Hench Foundation for supporting this research in type 1 diabetes recurrence after simultaneous kidney-pancreas transplantation.
Compliance with Ethical Standards
Conflict of Interest
George Burke reports receiving research funds from the John C. Hench Foundation to support work on Type I Diabetes recurrence after kidney-pancreas transplantation. Francesco Vendrama, Gaetano Ciancio, Mahmoud Morsi, Jose Figueiro, Linda Chen, and Alberto Pugliese declare no conflict of interest.
Human and Animal Rights and Informed Consent
This is a review, however, we reference our own work for which we have institutional approval for animal and human research, and informed consents for human research.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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