Five years outcomes from the Australian multicentre trial of islet transplantation
Philip O'Connell1, D. Jane Holmes-Walker1, David Goodman2, Wayne J Hawthorne1, Tom Loudovaris2, Jenny E Gunton1, Helen E Thomas2, Shane T Grey4, Christopher J Drogemuller3, Glen M Ward2, David J Torpy3, Patrick T Coates3, Tom W Kay2.
1National Pancreas Transplant Unit, University of Sydney at Westmead Hospital, Westmead, Australia; 2St Vincent's Medical Research Unit, St Vincent's Hospital, Melbourne, Australia; 3Renal Unit, Royal Adelaide Hospital, Adelaide, Australia; 4Immunology Divisoin, Garvan Institute of Medical Research, Sydney, Australia
Australian Islet Transplant Consortium..
Whilst the short term outcomes following islet transplantation are encouraging, the long term results remain a concern. The aim of this study was to evaluate 5 years outcomes of patients who were enrolled in the Australian Multicenter Islet Transplant trial
Methods: 17 patients were recruited to the study. One year outcomes are published1. There was a formal review annually, assessing clinical parameters, Edmonton hypoglycemia score, renal function, HbA1c, C-peptide and insulin requirements.
Results: At 12 months, 14 of the 17 patients achieved the primary end point of HbA1c <7% and cessation of hypoglycemia and 8 patients were insulin independent. A further 3 became insulin independent by 2 years (11 total). Of the 14 who achieved the primary endpoint, 11 continue to meet the primary endpoint criteria at 5 years. Two lost graft function at 4 years, one because of intolerance to immunosuppression. At 5 years, 11 of the remaining 12 patients with functioning grafts had an HbA1c < 7% (mean for the 14 patients 7.1±1.7%) and were free of hypoglycemia. Six of the 11 patients remained insulin independent at 5 years. Mean C-peptide was 0.5 ± 0.4 pmol/l and mean daily insulin dose was 12.9 ± 17.7 U. Renal function remained stable throughout the five years. Five patients had impaired renal function with an eGFR < 50 ml/min (Overall mean eGFR 60 ± 22 ml/min at 5 years). Maintenance immunosuppression consisted of mycophenolate mofetil and tacrolimus in 10 patients and 3 patients remained on protocol immunosuppression of sirolimus and an anti-metabolite (MMF or azathioprine). One patient developed sirolimus-induced pneumonitis, one patient required retinal laser photocoagulation within 1 year of transplant and one requires darbepoetin alpha for anaemia. Other side-effects have been relatively mild; predominantly lymphopenia and anaemia.
Conclusion: Of the 82% of patients who met the primary endpoint, 78% maintained the benefit for 5 years with excellent diabetic control and absence of hypoglycemia (61% of all original transplant recipients). This has been achieved with minimal side effects.
 O'Connell PJ et al. Am J Transplant 2013: 13; 1850-8
11:00 - 13:30
|Prospects for Clinical Islet Xenotransplantation (CIX)||Introduction||Room 109|
11:00 - 12:30
|Trends and progress in clinical islet transplantation||Five year outcomes from the Australian multicentre trial of islet transplantation||Plenary Room 1|
09:00 - 10:30
|Joint Presidential Session / Best Young Investigators Scientific Awards / 2017 Host Cities Presentations||Introduction by TTS President||Plenary Room 1|