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Islet transplantation in type 1 diabetics using an immunosuppressive protocol based on the anti-LFA-1 antibody efalizumab.
- Source :
-
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2010 Aug; Vol. 10 (8), pp. 1870-80. - Publication Year :
- 2010
-
Abstract
- The applicability of islet transplantation as treatment for type 1 diabetes is limited by renal and islet toxicities of currently available immunosuppressants. We describe a novel immunosuppressive regimen using the antileukocyte functional antigen-1 antibody efalizumab which permits long-term islet allograft survival while reducing the need for corticosteroids and calcineurin inhibitors (CNI). Eight patients with type 1 diabetes and hypoglycemic unawareness received intraportal allogeneic islet transplants. Immunosuppression consisted of antithymocyte globulin induction followed by maintenance with efalizumab and sirolimus or mycophenolate. When efalizumab was withdrawn from the market in mid 2009, all patients were transitioned to regimens consisting of mycophenolate and sirolimus or mycophenolate and tacrolimus. All patients achieved insulin independence and four out of eight patients became independent after single-islet transplants. Insulin independent patients had no further hypoglycemic events, hemoglobin A1c levels decreased and renal function remained stable. Efalizumab was well tolerated and no serious adverse events were encountered. Although long-term follow-up is limited by discontinuation of efalizumab and transition to conventional imunnosuppression (including CNI in four cases), these results demonstrate that insulin independence after islet transplantation can be achieved with a CNI and steroid-free regimen. Such an approach may minimize renal and islet toxicity and thus further improve long-term islet allograft survival.
- Subjects :
- Adolescent
Adult
Antibodies, Monoclonal, Humanized
Antilymphocyte Serum therapeutic use
Blood Glucose metabolism
Female
Humans
Immunosuppression Therapy methods
Male
Middle Aged
Mycophenolic Acid therapeutic use
Sirolimus therapeutic use
Tacrolimus administration & dosage
Antibodies, Monoclonal administration & dosage
Diabetes Mellitus, Type 1 surgery
Islets of Langerhans Transplantation methods
Lymphocyte Function-Associated Antigen-1 administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1600-6143
- Volume :
- 10
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
- Publication Type :
- Academic Journal
- Accession number :
- 20659093
- Full Text :
- https://doi.org/10.1111/j.1600-6143.2010.03073.x