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Type: Journal article
Title: Multicenter Australian trial of islet transplantation: Improving accessibility and outcomes
Author: O'Connell, P.
Holmes-Walker, D.
Goodman, D.
Hawthorne, W.
Loudovaris, T.
Gunton, J.
Thomas, H.
Grey, S.
Drogemuller, C.
Ward, G.
Torpy, D.
Coates, P.
Kay, T.
Citation: American Journal of Transplantation, 2013; 2013(13):1850-1858
Publisher: Blackwell Munksgaard
Issue Date: 2013
ISSN: 1600-6135
Statement of
P. J. O'Connell, D. J. Holmes-Walker, D. Goodman, W. J. Hawthorne, T. Loudovaris, J. E. Gunton, H. E. Thomas, S. T. Grey, C. J. Drogemuller, G. M. Ward, D. J. Torpy, P. T. Coates, T. W. Kay, and on behalf of the Australian Islet Transplant Consortium
Abstract: Whilst initial rates of insulin independence following islet transplantation are encouraging, long-term function using the Edmonton Protocol remains a concern. The aim of this single-arm, multicenter study was to evaluate an immunosuppressive protocol of initial antithymocyte globulin (ATG), tacrolimus and mycophenolate mofetil (MMF) followed by switching to sirolimus and MMF. Islets were cultured for 24 h prior to transplantation. The primary end-point was an HbA1c of <7% and cessation of severe hypoglycemia. Seventeen recipients were followed for ≥ 12 months. Nine islet preparations were transported interstate for transplantation. Similar outcomes were achieved at all three centers. Fourteen of the 17 (82%) recipients achieved the primary end-point. Nine (53%) recipients achieved insulin independence for a median of 26 months (range 7-39 months) and 6 (35%) remain insulin independent. All recipients were C-peptide positive for at least 3 months. All subjects with unstimulated C-peptide >0.2 nmol/L had cessation of severe hypoglycemia. Nine of the 17 recipients tolerated switching from tacrolimus to sirolimus with similar graft outcomes. There was a small but significant reduction in renal function in the first 12 months. The combination of islet culture, ATG, tacrolimus and MMF is a viable alternative for islet transplantation.
Keywords: Antithymocyte globulin (ATG); diabetes; graft function; hypoglycemia; insulin; insulin independence; islets; sirolimus; tacrolimus; transplantation
Rights: © Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons
DOI: 10.1111/ajt.12250
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