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21 May 2009

Pancreatic islets allotransplantations – indications and patients’ qualification

M Wszoła, A Kwiatkowski, K Pawelec, A Berman, P Fiedor, M Durlik, L Pączek, A Chmura

Ann Transplant 2009; 14(1): 46-46 :: ID: 880366

Abstract

Background: Diabetes and its complications are the growing problems in nowadays World. The new era of diabetes treatment was started when Banting and Best have discovered and isolated insulin from a dog's pancreas. Another break-through appeared after first successful pancreas transplantation. Unfortunately this type of treatment leads to many postoperative complications. Alternative treatment for patients with diabetes is pancreatic islets transplantations. In 2008 the first islets transplantation in Poland was done. It is still a matter of discussion the proper qualification and indications for this procedure. The aim of the study was to asses indications for islets transplantation.
Material/Methods: Between June and December 2008 one hundred twelve
patients with diabetes type I were observed in our outpatients clinic - 45 after kidney transplantation or unsuccessful pancreas/kidney transplantation and 67 without diabetic nephropathy. In the first round of qualifications the BMI, episodes of hypoglycemia, daily insulin intake and presence of diabetic complications were measured and observed. The group of 27 patients was hospitalized in order to perform more detailed assessments. The USG Doppler of portal vein and iliac arteries, gastroscopy, viral status assessments, metabolic assessments (peptide - C, HBA1C), biochemistry and morphology of blood and urine, ophthalmologic, dentist, cardiologic assessments were performed.
Results: Nine persons were disqualified from further study due to: chronic hepatitis B and C (4 prs), emotional instability (3 prs), type 2 -diabetes (2 prs). 18 persons had undergone qualifications for pancreatic islets transplantations: 9 patients with diabetic nephropathy (6 after Kidney transplantations and 3 under permanent dialysis treatment), 9 with unstable diabetes without nephropathy. Six of all were also qualified to pancreas transplantations. All patients were C-peptide negative. Mean age was 40.4±12 years, mean time of diabetes treatment was- 17±9 years, mean BMI was - 22.3±3 kg/m2, mean daily insulin intake was - 39±13 IU, mean clearance of creatinine was - 93±50 ml/min, mean level of HBA1C was - 7.99±2.33 mg%.
Conclusions: Patients with type-I diabetes with low daily insulin intake, low  BMI, good creatinine clearance and metabolic instability might be qualified for pancreatic islets transplantations.

Keywords: pancreatic islets

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Annals of Transplantation eISSN: 2329-0358
Annals of Transplantation eISSN: 2329-0358