Professor of Surgery
Division of Transplantation
University of Geneva Hospitals
Twenty years of allogeneic islet transplantation for type 1 diabetes in a single center: Trends and progresses
Thierry Berney1, Domenico Bosco1, Sandrine Demuylder-Mischler1, Benoît Bédat1, Mohamed Alibashe Ali1, Charlotte Barbieux1, Ekaterine Berishvili1,2, Estelle Brioudes1, Vanessa Lavallard1, Jeremy Meyer1, Géraldine Parnaud1, Nadja Niclauss1, Philippe Morel1.
1Cell Isolation and Transplantation Center - Dpt of Surgery, University of Geneva, Geneva, Switzerland; 2Institute of Medical Research, Ilia State University, Tbilisi, Georgia
The allogeneic islet transplantation program was initiated at the University of Geneva >20 years ago. Since then, and with the collaborative Swiss-French GRAGIL network, >350 islet transplants have been performed in >250 patients. Of these, 62 patients were transplanted locally. The purpose of this study is to review the trends and progresses made in the field at a single institution over this time period.
These twenty years were divided into 4 eras, depending on immunosuppressive protocol. In era 1 (1994-1996), 6 patients were transplanted on ATG/CsA/Aza/Steroid; in era 2 (1997-2000), 12 patients on anti-IL2R/Tac/MMF/steroid; in era 3 (2001-2007), 25 patients on anti-IL2R/Rapa/Tac; in era 4 (2008-2015) 19 patients on ATG/anti-TNF/Tac/MMF.
Graft survival (C-peptide >0.5 ng/ml) was 67%, 50% and 33% in era 1, 67%, 33% and 33% in era 2, 96%, 81% and 57% in era 3, and 100%, 100% and n.a. in era 4 at 1, 5 and 10 years. Insulin independence was 17%, 17% and 17% in era 1, 8%, 0% and 0% in era 2, 68%, 28% and 11% in era 3, and 85%, 51% and n.a. in era 4 at 1, 5 and 10 years.
Over the years, the main indication for islet transplantation evolved from 40% SIK, 60% IAK, 0% ITA in era 1, to 20% SIK, 33% IAK and 47% ITA in era 4. Six transplants were performed in patients with cystic fibrosis, either simultaneously with the lung (N=2) or after lung (N=4).
In a multivariate analysis, type of transplant (SIK, IAK or ITA) had no impact on graft function or insulin independence. Factors significantly associated with better graft outcome (insulin independence and/or C-peptide positivity) were era, use of ATG and number of transplants.
This series illustrates the progresses made in islet allogeneic transplantation over the past 2 decades and the trends in immunosuppression and indications for islet transplantation.
13:30 - 15:00
|Pancreas & Islet Allotransplantation: Towards Unifying Beta Cell Replacement Therapy||Patient selection for alloislet vs. allopancreas||Plenary Room 1|
13:00 - 16:15
|Pancreas Transplantation: Global Trends in Pancreas Transplantation – challenges and opportunities||Challenges: Emerging therapies||Room 110|
11:00 - 12:30
|Trends and progress in clinical islet transplantation||Twenty years of allogeneic islet transplantation for type 1 diabetes in a single center : Trends and progresses||Plenary Room 1|