Transplant boost for some type 1 diabetes patients

Islet transplantation could be a game changer for kidney transplant patients with type 1 diabetes, a European conference has heard.

It was found to boost survival rates and reduce the risk of transplantation failure, according to French and Swiss researchers.

Researchers behind the study, presented at the European Society for Organ Transplantation (ESOT) Congress 2023, in Athens, Greece, say their findings should give hope for people living with type 1 diabetes and kidney transplants.

The teams compared the long-term outcomes of patients with type 1 diabetes who underwent kidney transplantation and received an islet transplantation – when extracted islet cells from the pancreas of a deceased donor are implanted into the liver of a patient with type 1 diabetes – with patients who underwent kidney transplantation and then managed their diabetes with insulin alone.

They analysed every patient with type 1 diabetes in France who received a kidney transplant between 2000 and 2017.

Of the 2,393 patients, 327 were eligible for islet transplantation and 47 received islet transplantation.

The researchers matched patients based on factors, such as the year of transplantation, age of the recipient, kidney function, or HBA1c and after comparing the two groups, it was ascertained that islet transplantation had a significant benefit over insulin alone in terms of reducing the risk of transplantation failure and death.

There was a 0.47 hazard ratio for graft failure in the islet transplantation group, indicating a 53% lower risk of failure compared with the insulin-only group. Patients who received an islet transplantation also had a higher estimated life expectancy at 9.61 years compared with 8.85 years for those on insulin alone.

When analysing the outcomes of islet transplantation alone, the researchers found that at the one-year mark following the islet transplantation, there was an estimated 89.4% probability of graft survival. Patients were also estimated to have a 70.2% probability of being able to give up insulin after one year.

Lead study author Dr Mehdi Maanaoui, from the University of Lille, France, said: “Although islet transplantation has previously been shown to improve glycaemic control compared with conventional insulin therapy in recent clinical trials, little was known about its long-term impact on patient prognosis until now.

“These results are exciting and provide hope for people living with type 1 diabetes and kidney transplants.

“Islet transplantation could be a game-changer in the management of type 1 diabetes, and our research demonstrates a clear association between islet transplantation and a substantial increase in life expectancy.”

Maanaoui M, et al. Islet transplantation versus insulin alone in type 1 diabetic kidney transplant recipients: a French nationwide study on behalf of the TREPID group. Presented at the European Society for Organ Transplantation Congress.

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