Type I Diabetics Often Relapse After Islet Transplant
Researchers find that most patients with good initial response need insulin again after two years
WEDNESDAY, Sept. 27 (HealthDay News) -- In patients with unstable type 1 diabetes, islet transplantation can restore endogenous insulin production and glycemic stability, but insulin independence is usually not sustainable, according to a report in the Sept. 28 issue of the New England Journal of Medicine.
A.M. James Shapiro, M.D., of the University of Alberta in Edmonton, Canada, and colleagues studied 36 transplant patients.
Sixteen (44 percent) of the subjects met the primary end point -- insulin independence with adequate glycemic control one year after the final transplantation. Ten (28 percent) had partial function and 10 (28 percent) had complete graft loss. Although 21 subjects (58 percent) attained insulin independence with good glycemic control during the trial, 16 of them (76 percent) required insulin again after two years.
"Islet transplantation is at a crossroads," state the authors of an accompanying editorial. "It is clear that poor long-term results, high costs, and the relatively high incidence of major and minor serious adverse events make it difficult to argue for expansion of islet transplantation to the general population. Nonetheless, the dramatic discoveries and successful dissemination of information in a relatively short period encourage us to believe these advances will continue apace."
Immunosuppressive agents used in the study were provided by Astellas, Wyeth and Roche, which also provided grants and other compensation to some authors.