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Recurrence of type 1 diabetes after simultaneous pancreas-kidney transplantation in the absence of GAD and IA-2 autoantibodies

Demuylder-Mischler, S
Published in American Journal of Transplantation. 2012, vol. 12, no. 2, p. 492-5
Abstract We report herein the patterns of type 1 diabetes recurrence in a simultaneous pancreas-kidney transplant (SPK) recipient, in the absence of rejection. A 38-year-old female underwent SPK for end-stage nephropathy secondary to type 1 diabetes. Fasting blood glucose, HbA1c, fructosamine, C-peptide and autoantibodies (GAD-65, IA-2) were monitored throughout follow-up. At 3.5 years post-SPK, HbA1c and fructosamine increased sharply, indicating loss of perfect metabolic control, despite C-peptide levels in the normal-high range. Exogenous insulin was restarted 4 months later. C-peptide levels abruptly fell and became undetectable at 5.5 years. Autoantibody levels, which were undetectable at the time of SPK, never converted to positivity. Pancreas retranspantation was performed at 6 years. The failed pancreas graft had a normal macroscopic appearance. On histology, there were no signs of cellular or humoral rejection in the kidney or pancreas. A selective peri-islet lymphocytic infiltrate was observed, together with near-total destruction of β cells. At 2.5 years post retransplantation, pancreatic graft function is perfect. This observation indicates unequivocally that pancreas graft can be lost to recurrence of type 1 diabetes in the absence of rejection. GAD-65 and IA-2 autoantibodies are not reliable markers of autoimmunity recurrence.
Keywords AdultAutoantibodies/blood/immunologyAutoimmunityDiabetes Mellitus, Type 1/complications/immunology/surgeryDiabetic Nephropathies/complications/immunology/surgeryFemaleFollow-Up StudiesGlutamate Decarboxylase/blood/immunologyHumansKidney Failure, Chronic/etiology/immunology/surgeryKidney Transplantation/immunologyPancreas Transplantation/immunologyRecurrenceReoperation
PMID: 22151900
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Research groups Chirurgie viscérale (104)
Transplantation et hépatologie (905)
La transplantation d'îlots de Langerhans (623)
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ASSALINO, Michela et al. Recurrence of type 1 diabetes after simultaneous pancreas-kidney transplantation in the absence of GAD and IA-2 autoantibodies. In: American Journal of Transplantation, 2012, vol. 12, n° 2, p. 492-5. https://archive-ouverte.unige.ch/unige:27507

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Deposited on : 2013-04-17

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