Differences in Baseline Lymphocyte Counts and Autoreactivity Are Associated With Differences in Outcome of Islet Cell Transplantation in Type 1 Diabetic Patients

被引：84

作者：

Hilbrands, Robert ^{[1
,2
,3
]}

Huurman, Volkert A. L. ^{[3
,4
]}

Gillard, Pieter ^{[1
,2
,3
,5
]}

Velthuis, Jurjen H. L. ^{[3
,4
]}

De Waele, Marc ^{[1
,2
]}

Mathieu, Chantal ^{[3
,5
]}

Kaufman, Leonard ^{[6
]}

Pipeleers-Marichal, Miriam ^{[1
,2
]}

Ling, Zhidong ^{[1
,2
,3
]}

Movahedi, Babak ^{[1
,2
,3
]}

Jacobs-Tulleneers-Thevissen, Daniel ^{[1
,2
,3
]}

Monbaliu, Diethard ^{[7
]}

Ysebaert, Dirk ^{[8
]}

Gorus, Frans K. ^{[1
,2
,3
]}

Roep, Bart O. ^{[3
,4
]}

Pipeleers, Daniel G. ^{[1
,2
,3
]}

Keymeulen, Bart ^{[1
,2
,3
]}

机构：

[1] Vrije Univ Brussel, Free Univ Brussels, Diabet Res Ctr, Brussels, Belgium

[2] Vrije Univ Brussel, Free Univ Brussels, Universitair Ziekenhuis Brussels, Brussels, Belgium

[3] Juvenile Diabet Res Fdn, Ctr Cell Therapy Diabet, Brussels, Belgium

[4] Leiden Univ, Med Ctr, Dept Immunohematol & Blood Transfus, Leiden, Netherlands

[5] Catholic Univ Louvain, Dept Endocrinol, Universitair Ziekenhuis Brussels, B-3000 Louvain, Belgium

[6] Brussels Free Univ VUB, Dept Biostat, Brussels, Belgium

[7] Catholic Univ Louvain, Universitair Ziekenhuis Brussels, Dept Surg, B-3000 Louvain, Belgium

[8] Univ Antwerp, Universitair Ziekenhuis Brussels, Dept Surg, B-2020 Antwerp, Belgium

来源：

DIABETES | 2009年 / 58卷 / 10期

关键词：

B-CELLS; INSULIN-INDEPENDENCE; ANTIGEN PRESENTATION; TOTAL PANCREATECTOMY; ALLOGRAFT SURVIVAL; CULTURED ISLETS; LIVER SEGMENT; MELLITUS; GRAFT; IMMUNOSUPPRESSION;

D O I：

10.2337/db09-0160

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

OBJECTIVE-The metabolic outcome of islet cell transplants in type 1 diabetic patients is variable. This retrospective analysis examines whether differences in recipient characteristics at the time of transplantation are correlated with inadequate graft function. RESEARCH DESIGN AND METHODS-Thirty nonuremic C-peptide-negative type 1 diabetic patients had received an intraportal islet cell graft of comparable size under an ATG-tacrolimus-mycophenolate mofetil regimen. Baseline patient characteristics were compared with outcome parameters during the first 6 posttransplant months (i.e., plasma C-peptide, glycemic variability, and gain of insulin independence). Correlations in univariate analysis were further examined in a multivariate model. RESULTS-Patients that did not become insulin independent exhibited significantly higher counts of B-cells as well as a T-cell autoreactivity against insulinoma-associated protein 2 (IA2) and/or GAD. In one of them, a liver biopsy during posttransplant year 2 showed B-cell accumulations near insulin-positive P-cell aggregates. Higher baseline total lymphocytes and T-cell autoreactivity were also correlated with lower plasma C-peptide levels and higher glycemic variability. CONCLUSIONS-Higher total and B-cell counts and presence of T-cell autoreactivity at baseline are independently associated with lower graft function in type 1 diabetic patients receiving intraportal islet cells under ATG-tacrolimus-mycophenolate mofetil therapy. Prospective studies are needed to assess whether control of these characteristics can help increase the function of islet cell grafts during the first year posttransplantation. Diabetes 58:2267-2276, 2009

引用

页码：2267 / 2276

页数：10

共 52 条

[1] Factors associated with insulin and narcotic independence after islet autotransplantation in patients with severe chronic pancreatitis [J].