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Title

Insulin-heparin infusions peritransplant substantially improve single-donor clinical islet transplant success

Authors
Koh, Angela
Senior, Peter
Salam, Abdul
Kin, Tatsuya
Imes, Sharleen
Dinyari, Parastoo
Malcolm, Andrew
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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 AdultAnticoagulants/administration & dosage/therapeutic useAntithrombins/analysisBlood Glucose/metabolismDiabetes Mellitus, Type 1/blood/ surgeryDrug Administration ScheduleFemaleHeparin, Low-Molecular-Weight/administration & dosage/ therapeutic useHumansHypoglycemic Agents/administration & dosage/therapeutic useInsulin/administration & dosage/ therapeutic useIslets of Langerhans Transplantation/ physiologyMaleMiddle AgedMultivariate AnalysisPatient SelectionPerioperative Care/ methodsRegression AnalysisRetrospective StudiesThrombin/analysisTissue Donors/ statistics & numerical dataTreatment Outcome
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PMID: 20177350
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Research group Transplantation et hépatologie (905)
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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. https://archive-ouverte.unige.ch/unige:20692

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Deposited on : 2012-05-23

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