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Diabetes Publish Ahead of Print published online ahead of print July 15, 2008
DOI: 10.2337/db08-0358
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Original Research

Simultaneous Islet-Kidney Transplantation in 7 Patients of Type 1 Diabetes with End-stage Renal Disease using a glucocorticoid-free immunosuppressive regimen with alemtuzumab induction

Jianming Tan, MD. PhD1, Shunliang Yang, MD1, Jinquan Cai, MD1, Junqi Guo, MD. PhD1, Lianghu Huang, MD1, Zhixian Wu, MD1, Jin Chen, MD1, and Lianming Liao, PhD1

Organ Transplant Institute, Fuzhou General Hospital, Fuzhou, 350025, P. R. China

OBJECTIVE—: The aim of this study was to evaluate the efficiency and safety of simultaneous islet-kidney transplantation in patients of type 1 diabetes with end-stage renal disease using a glucocorticoid-free immunosuppressive regimen with alemtuzumab induction.

RESEARCH DESIGN AND METHODS—: Seven patients with type 1 diabetes and end-stage renal failure were transplanted with allogenic islets and kidneys procured from brain dead donors. To prevent organ rejection, patients received alemtuzumab for induction immunosuppression, followed by sirolimus and tacrolimus. No glucocorticoids were given at any time.

RESULTS—: The median duration of follow-up was 18.3 months (range, 13 to 31 months). Kidney survival was 100%. Four patients became insulin independent at 1 year. The other 3 reduced the insulin use to less than 25% of the amount required before transplantation. Serum C-peptide levels were significantly greater post-transplant in all patients, indicating continued islet function. No major procedure-related complications were observed.

CONCLUSIONS—: Our results demonstrates that steroid-free immunosuppressive regimen consisting of alemtuzumab, sirolimus and tacrolimus are feasible for simultaneous islet-kidney transplantation. Whether this induction regimen is superior to more standard induction deserves large studies.

Correspondence: doctortjm{at}yahoo.com


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