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• W2018716470 abstract "O453 Aims: Recent advances in clinical islet transplantation in preuremic type 1 diabetics have shown that if enough islets are transplanted one can achieve an insulin independence of 80 percent at one year. Islet isolation is still a procedure requiring both ample experience and substantial resources. These facts inspired us to start the Nordic Network for Clinical Islet Transplantation, in 2001, with one central isolation lab and six clinical centers. In our first study we have transplanted 18 uremic patients with functioning kidney grafts and therefore already on immunosuppressant medication. Methods: Patients were switched to the Edmonton Protocol (Tacrolimus, Sirolimus and Daclizumab). Steroids were withdrawn either when put on the waiting list or in conjunction with the first islet transplantation. Pancreases were harvested at the participating centers and sent to a central islet isolation lab in Uppsala, Sweden. After the isolation process the islets were transported to a center with a suitable ABO compatible patient. In the first two patients, fresh islets were transplanted, in the following islets had been in culture for 24-96h. The transplantations were performed through a percutaneous transhepatic portal injection and repeated to a maximum of four transplantations. Results: 44 transplantations have been carried out. 26 of them since Jan 1st 2003. All centers have delivered pancreases used for the transplantations. Five centers have transplanted patients. None of the two patients transplanted with fresh islets became insulin independent, but this was achieved in 6/8 of the following patients after 2-4 transplantations (a total of 7500-28000 IEQ/kgBW). After a 3-28 month follow up, 4 are still insulin free. Two of them have been treated at a center more than 500 km from the isolation lab. Another 8 patients have received 1-3 doses of islets and are waiting for further transplantations. 7 of these 8 “ongoing” patients have partial function (C-peptides >0.2 nmol/L) with a reduction of insulin requirements and stabilisation of blood glucose. 4 of them have so far received only 1 transplant. One patient died of a cerebral haemorrhage 6 months after the last islet transplant. Two patients have had pulmonary changes probably caused by Sirolimus. One of these patients needed treatment in the ICU. One of the insulin free patients had a minor pneumothorax after his first transplantation. Another pat was transfused with two units of SAG-blood due to haemorrhage following two out of four transplantations. Other, more frequent, adverse events include leucopoenia and mouth ulcers. Conclusions: Using the Edmonton Protocol can improve the results of islet transplantation not only in preuremic diabetics but also in previously kidney transplanted patients. The amount of islets needed to achieve insulin independence varies substantially. Strategies to enhance engraftment and reduce the loss of islets immediately following the transplantation are currently being developed." @default.
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• W2018716470 date "2004-07-01" @default.
• W2018716470 modified "2023-10-06" @default.
• W2018716470 title "THE NORDIC NETWORK FOR CLINICAL ISLET TRANSPLANTATION - ISLET AFTER KIDNEY (IAK) - RESULTS AND EXPERIENCES FROM THE FIRST 44 TRANSPLANTATIONS." @default.
• W2018716470 doi "https://doi.org/10.1097/00007890-200407271-00466" @default.
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