Consultant Transplant Surgeon
Dept of Clinical Surgery
Royal Infirmary of Edinburgh/University of Edinburgh
Islet transplantation in the United Kingdom- Data from the UK Transplant Registry
Sue Madden1, Lisa Bradbury1, Lora Irvine3, GuoCai Huang6, Stephen Hughes2, Vaughan Carter10, Susan Fuggle9, Miranda Rosenthal4, Gareth Jones4, Rommel Ravanan7, Martin Rutter11, Stephanie Amiel6, Pratik Choudhary6, Shareen Forbes5, Paul Johnson2, James Shaw8, John Casey5.
1NHSBT ODT, Bristol, United Kingdom; 2Nuffield Department of Surgical Sciences, Oxford University, Oxford, United Kingdom; 3Scottish National Islet Transplant Laboratory, SNBTS, Edinburgh, United Kingdom; 4Royal Free Hospital, London, United Kingdom; 5Royal Infirmary of Edinburgh/University of Edinburgh, Edinburgh, United Kingdom; 6Kings College London, London, United Kingdom; 7Bristol Islet Transplant Programme, Bristol, United Kingdom; 8Institute of Transplantation, University of Newcastle, Newcastle, United Kingdom; 9Transplant Immunology & Immunogenetics, Oxford Transplant Centre, Oxford, United Kingdom; 10NHSBT, Newcastle, United Kingdom; 11Manchester Islet Transplant Programme, CMFT, Manchester, United Kingdom
UK Islet Steering Group. UK Islet Transplant Consortium.
Islet transplantation for the reversal of severe hypoglycaemia in people with Type I diabetes was commissioned by the UK National Health Service in 2008. In 2010, a single pancreas allocation scheme was introduced in the UK for both islet and whole pancreas recipients resulting in a substantial increase in islet transplant activity. Seven transplant centres and 3 isolation facilities form an integrated “hub and spoke” service and compulsory data reporting is a legal requirement of service commissioning. Here we report the activity and outcomes of the UK islet service.
146 islet transplants were carried out in 92 patients between April 2008 and December 2014. Both DBD and DCD pancreata were offered to named patients through the UK pancreas allocation scheme and isolated at one of the 3 isolation laboratories. Suitable islet preps were then transported to the transplanting centre for infusion. The key outcome measures are graft function, HbA1c, annual rate of severe hypoglycaemic events and insulin dose. Although recorded, insulin independence is not a key aim of this service. One year outcome data are presented here on the 75 patients transplanted up to December 2013 with 1 year follow up.
The median rate of severe hypoglycaemic events fell from 11 (IQR 1-50) pre transplant to 0 (IQR 0-0) at one year post transplant. Median HbA1c fell from 8.0% (IQR 7.2-9.4%) at the time of transplant to 6.8% (IQR 6.0- 7.5%) at one year post transplant. Insulin dose was reduced from 0.52 units/kg (IQR 0.38-0.62) pre transplant to 0.30units/kg (IQR 0.14 to 0.40) post transplant. Kaplan-Meier estimated 1 year graft survival in this group is 82%, 95% CI (70-90).
These data demonstrate that patients with diabetes in the UK have access to a government funded islet transplant programme which effectively reverses severe hypoglycaemia and improves glycaemic control.
11:00 - 12:30
|Trends and progress in clinical islet transplantation||Islet transplantation in the United Kingdom- Data from the UK Transplant Registry||Plenary Room 1|