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Insulin-heparin infusions peritransplant substantially improve single-donor clinical islet transplant success
|Published in||Transplantation. 2010, vol. 89, no. 4, p. 465-471|
|Abstract||BACKGROUND: Successful islet transplantation can result in insulin independence in many patients with type 1 diabetes mellitus, but it often requires more than one islet infusion. The ability to achieve insulin independence with a single donor is an important goal in clinical islet transplantation due to the limited organ supply. METHODS: We examined factors that may be associated with insulin independence after islet transplantation with islets from a single donor, using univariate and multivariate analysis. RESULTS: Thirteen of 85 (15.3%) achieved insulin independence after single-donor islet transplantation. Using multivariate analysis, only the use of insulin and heparin infusions peritransplant was a significant factor associated with insulin independence, with an adjusted odds ratio of 8.6 (95% confidence interval 2.0-37.0). Patients who had received insulin and heparin infusions peritransplant had greater indices of islet engraftment and a greater reduction in insulin use (80.1% + or - 4.3% vs. 54.2% + or - 2.8%, P<0.001) even if insulin independence was not achieved. CONCLUSIONS: Peritransplant intensive insulin and heparin enhances islet transplantation outcomes likely related in part to mitigation of the effects of the instant blood-mediated inflammatory reaction, combined with islet rest and avoidance of inflammation. It would be important to further investigate the effects of peritransplant insulin and heparin infusions on islet engraftment.|
|Keywords||Adult — Anticoagulants/administration & dosage/therapeutic use — Antithrombins/analysis — Blood Glucose/metabolism — Diabetes Mellitus, Type 1/blood/ surgery — Drug Administration Schedule — Female — Heparin, Low-Molecular-Weight/administration & dosage/ therapeutic use — Humans — Hypoglycemic Agents/administration & dosage/therapeutic use — Insulin/administration & dosage/ therapeutic use — Islets of Langerhans Transplantation/ physiology — Male — Middle Aged — Multivariate Analysis — Patient Selection — Perioperative Care/ methods — Regression Analysis — Retrospective Studies — Thrombin/analysis — Tissue Donors/ statistics & numerical data — Treatment Outcome|
|Research group||Transplantation et hépatologie (905)|
|KOH, Angela et al. Insulin-heparin infusions peritransplant substantially improve single-donor clinical islet transplant success. In: Transplantation, 2010, vol. 89, n° 4, p. 465-471. doi: 10.1097/TP.0b013e3181c478fd https://archive-ouverte.unige.ch/unige:20692|