TY - JOUR
T1 - Insulin independence after islet transplantation into type I diabetic patient
AU - Scharp, David W.
AU - Lacy, Paul E.
AU - Santiago, Julio V.
AU - Mccullough, Christopher S.
AU - Weide, Lamont G.
AU - Falqui, Luca
AU - Marchetti, Piero
AU - Gingerich, Ronald L.
AU - Jaffe, Allan S.
AU - Cryer, Philip E.
AU - Anderson, Charles B.
AU - Flye, M. Wayne
PY - 1990/4
Y1 - 1990/4
N2 - Effective clinical trials of islet transplantation have been limited by the inability to transplant enough viable human islets into patients with type I (insulin-dependent) diabetes mellitus to eliminate their exogenous insulin requirement. We report the first type I diabetic patient with an established kidney transplant on basal cyclosporin immunosuppression who was able to eliminate the insulin requirement after human islet transplantation into the portal vein. We successfully isolated ∼800,000 islets that were 95% pure from 1.4 cadaver pancreases containing 121 U of insulin. Islets were proven viable by in vitro insulin response to glucose challenge. After 7 days of 24°C culture, the islets were transplanted into the portal vein under local anesthesia. Seven days of Minnesota antilymphoblast globulin (20 mg/kg) administration followed the islet transplantation, with maintenance of the cyclosporin. Blood glucose was kept under strict control via intravenous insulin for 10 days posttransplantation, when all insulin therapy was stopped. Off insulin, the average 24-h blood glucose level remained <150 mg/dl, with the fasting glucose level at 115 ± 6 mg/dl and the 2-h postprandial level at 141 ± 8 mg/dl for 22 days posttransplantation (the time of this study). The C-peptide values post-Sustacal testing, although initially rising slower, exceeded the normal range, with peak values of 1.0-1.8 pmol/ml. This preliminary result represents the first essential step required to determine the feasibility of islet transplantation by future clinical trials.
AB - Effective clinical trials of islet transplantation have been limited by the inability to transplant enough viable human islets into patients with type I (insulin-dependent) diabetes mellitus to eliminate their exogenous insulin requirement. We report the first type I diabetic patient with an established kidney transplant on basal cyclosporin immunosuppression who was able to eliminate the insulin requirement after human islet transplantation into the portal vein. We successfully isolated ∼800,000 islets that were 95% pure from 1.4 cadaver pancreases containing 121 U of insulin. Islets were proven viable by in vitro insulin response to glucose challenge. After 7 days of 24°C culture, the islets were transplanted into the portal vein under local anesthesia. Seven days of Minnesota antilymphoblast globulin (20 mg/kg) administration followed the islet transplantation, with maintenance of the cyclosporin. Blood glucose was kept under strict control via intravenous insulin for 10 days posttransplantation, when all insulin therapy was stopped. Off insulin, the average 24-h blood glucose level remained <150 mg/dl, with the fasting glucose level at 115 ± 6 mg/dl and the 2-h postprandial level at 141 ± 8 mg/dl for 22 days posttransplantation (the time of this study). The C-peptide values post-Sustacal testing, although initially rising slower, exceeded the normal range, with peak values of 1.0-1.8 pmol/ml. This preliminary result represents the first essential step required to determine the feasibility of islet transplantation by future clinical trials.
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U2 - 10.2337/diab.39.4.515
DO - 10.2337/diab.39.4.515
M3 - Article
C2 - 2108071
AN - SCOPUS:0025269474
SN - 0012-1797
VL - 39
SP - 515
EP - 518
JO - Diabetes
JF - Diabetes
IS - 4
ER -