1. A Comparative Analysis of the Safety, Efficacy, and Cost of Islet Versus Pancreas Transplantation in Nonuremic Patients With Type 1 Diabetes
- Author
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Moassesfar, S, Masharani, U, Frassetto, LA, Szot, GL, Tavakol, M, Stock, PG, and Posselt, AM
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Autoimmune Disease ,Diabetes ,Pediatric ,Transplantation ,Metabolic and endocrine ,Adult ,Cost-Benefit Analysis ,Diabetes Mellitus ,Type 1 ,Female ,Follow-Up Studies ,Glomerular Filtration Rate ,Graft Rejection ,Graft Survival ,Humans ,Islets of Langerhans Transplantation ,Kidney Function Tests ,Length of Stay ,Male ,Middle Aged ,Pancreas Transplantation ,Prognosis ,Risk Factors ,Safety ,clinical research ,practice ,islet transplantation ,pancreas ,simultaneous pancreas-kidney ,type 1 ,islet isolation ,insulin ,C-peptide ,islets of Langerhans ,Medical and Health Sciences ,Surgery ,Clinical sciences ,Immunology - Abstract
Few current studies compare the outcomes of islet transplantation alone (ITA) and pancreas transplantation alone (PTA) for type 1 diabetes (T1D). We examined these two beta cell replacement therapies in nonuremic patients with T1D with respect to safety, graft function and cost. Sequential patients received PTA (n = 15) or ITA (n = 10) at our institution. Assessments of graft function included duration of insulin independence; glycemic control, as measured by hemoglobin A1c; and elimination of severe hypoglycemia. Cost analysis included all normalized costs associated with transplantation and inpatient management. ITA patients received one (n = 6) or two (n = 4) islet transplants. Mean duration of insulin independence in this group was 35 mo; 90% were independent at 1 year, and 70% were independent at 3 years. Mean duration of insulin independence in PTA was 55 mo; 93% were insulin independent at 1 year, and 64% were independent at 3 years. Glycemic control was comparable in all patients with functioning grafts, as were overall costs ($138 872 for ITA, $134 748 for PTA). We conclude that with advances in islet isolation and posttransplant management, ITA can produce outcomes similar to PTA and represents a clinically viable option to achieve long-term insulin independence in selected patients with T1D.
- Published
- 2016