Islet transplantation as a treatment for hypoglycemia unawareness syndrome. Evaluation of the pilot program and comparison with pancreas transplantation
Authors:
Martina Zahradnická 1; Peter Girman 1; Jan Kříž 1; Zuzana Berková 2; Tomáš Koblas 2; Ema Vávrová 1; Lucie Kosinová 2; David Habart 2; Eva Fábryová 2; Eva Dovolilová 2; Tomáš Neškudla 1; MUDr. Jan Peregrin 3; Jozef Kováč 3; Květoslav Lipár 4; Matěj Kočík 4; Lenka Németová 1; Jiří Svoboda 5; František Saudek 1
Authors place of work:
Klinika diabetologie, IKEM, Praha
1; Centrum experimentální medicíny IKEM, Praha
2; Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha
3; Klinika transplantační chirurgie, IKEM
4; Oddělení datového centra IKEM, Praha
5
Published in the journal:
Čas. Lék. čes. 2016; 155: 349-356
Category:
Original Article
Summary
Islet transplantation (ITx) started in 2005 in IKEM as a potentially safer alternative to pancreas transplantation (PTx), which so far had represented the method of choice in type-1 diabetic patients with conservatively intractable hypoglycemia unawareness syndrome. The aim of the study was to compare these two methods with regard to severe hypoglycemia elimination and to frequency of complications.
Up to November 2015 a total number of 48 patients underwent ITx. The results from 22 patients with hypoglycemia unawareness were statistically analyzed. The mean number of transplanted islet equivalents was 12,096 (6,933−16,705) IEQ/kg administered percutaneously in local anesthesia under radiological control to the portal vein. 44 patients underwent PTx from 1996. We evaluated glycated hemoglobin(HbA1c), insulin dose, fasting and stimulated C-peptide, frequency of severe hypoglycemia and complications. Medians (interquartile range) were analyzed using the Wilcoxon signed-rank test.
One and two years after ITx, HbA1c decreased, C-peptide became significantly positive, insulin dose and frequency of severe hypoglycemia decreased and 18 % of ITx recipients were temporarily insulin-independent. Bleeding was present in 41 % of patients. One year after PTx, 73 % of patients were insulin and hypoglycemia-free, after two years 68 % of patients were insulin and hypoglycemia-free; graftectomy occurred in 20 % of recipients.
Both methods led to restoration of insulin secretion and severe hypoglycemia elimination. PTx made more recipients insulin-independent at the cost of serious complications.
Keywords:
islet transplantation, pancreas transplantation, complications, hypoglycemia
Zdroje
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Štítky
Addictology Allergology and clinical immunology Angiology Audiology Clinical biochemistry Dermatology & STDs Paediatric gastroenterology Paediatric surgery Paediatric cardiology Paediatric neurology Paediatric ENT Paediatric psychiatry Paediatric rheumatology Diabetology Pharmacy Vascular surgery Pain management Dental HygienistČlánok vyšiel v časopise
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