Successful Islet Transplantation
Continued Insulin Reserve Provides Long-Term Glycemic Control
Article Figures & Tables
Figures
- FIG. 1.
A: HbA1c at 3-month intervals after islet transplantation in subjects who remained insulin independent (n = 11). Each line represents an individual subject. B: Plasma glucose levels derived from standard meal tolerance tests in control subjects (n = 10) and patients before and after islet transplantation who have remained insulin independent (n = 11). Values are means ± SE. C: Plasma C-peptide levels derived from standard meal tolerance tests in control subjects (n = 10) and patients before and after islet transplantation who have remained insulin independent (n = 11). Values are means ± SE. Levels pretransplant were below detectability of the assay.
- FIG. 2.
Fasting plasma C-peptide levels during the first 4 weeks (top panel) and at 3-month intervals for the full duration of follow-up (lower panel) in the 11 patients who remained insulin independent. Shown also are the values pretransplant (pre-Tx) and after the first transplant (mid). Values are means ± SE.
- FIG. 3.
Exogenous insulin use (units/kg) in relation to the number of islets transplanted (IE/kg). Values for pretransplant (•), after first transplant (□), after second transplant (⧫), and after the third procedure (○) are shown. All patients became insulin independent once adequate islet numbers were provided.
- FIG. 4.
AIRg (A) and AUCi (B) over time in insulin-independent subjects (n = 11) before and after islet transplantation as derived from the IVGTT. The number of subjects studied is shown across the top of the figure. Mean values ± SE are provided for each time point. Values for all time periods up to 24 months are significantly different from those of control subjects.
- FIG. 5.
A: Relationship of the number of islets transplanted and AIRarg as derived from intravenous arginine infusion test at midtransplant (n = 6) and 3 months (n = 3) after transplant. B: Relationship of AUCi and the number of islets transplanted as derived from IVGTT at midtransplant (n = 13) and 3 months (n = 13) after transplant.
- FIG. 6.
A: Relationship of AIRg as derived from IVGTT and fasting plasma glucose in subjects after islet transplant who were not taking exogenous insulin. B: Relationship of AIRg as derived from IVGTT and 2-h plasma glucose during the OGTT in subjects after islet transplant who were not taking exogenous insulin.
Tables
- TABLE 1
Measures of insulin secretion after the first and final transplant
After first transplant After final transplant IE infused 374,283 ± 20,247 850,035 ± 37,911 AIRg (% of control) 2 ± 1 21 ± 5 AIRarg (% of control) 17 ± 3 56 ± 11 AUCi (% of control) 10 ± 4 34 ± 5 Data are means ± SE based on the 17 subjects (for IE infused) who completed the Edmonton protocol; n = 13 for the glucose studies (both after first and final transplant) and n = 6 after first transplant and n = 8 after final transplant for the arginine studies. Nondiabetic subjects are reported as having 1.0–1.7 × 106 islets (23,24).
- TABLE 2
Relationship of both IE transplanted and the cold ischemic index with measures of insulin secretion and glucose disposal
n r P Islet equivalents versus AIRg 26 0.463 0.017 AIRarg 9 0.789 0.011 AUCi 26 0.501 0.009 AUCC-p 26 0.522 0.006 KG 26 0.490 0.011 Cold ischemia index versus AIRg 26 0.589 0.002 AIRarg 9 0.827 0.006 AUCi 26 0.684 <0.001 AUCC-p 26 0.728 <0.001 KG 26 0.684 <0.001 The cold ischemia index is based on the cold ischemia time and the number of islets transplanted (4). The measures of insulin secretion are AIRg, μU/ml; AIRarg, μU/ml; AUCi, μU · ml−1 · min−1; and AUCC-p, nmol · l−1 · min−1.
- TABLE 3
Relationship of glycemia (fasting plasma glucose and the 2-h glucose during the OGTT) with measures of insulin secretion and glucose disposal
n r P Fasting plasma glucose versus AIRg 61 −0.485 <0.001 AIRarg 14 −0.075 0.8 AUCi 61 −0.422 <0.001 AUCC-p 61 −0.434 <0.001 KG 61 −0.35 0.006 2-h Glucose post-OGTT versus AIRg 28 −0.748 <0.001 AIRarg 4 −0.8 0.2 AUCi 28 −0.74 <0.001 AUCC-p 28 −0.69 <0.001 KG 28 −0.474 0.011 Measure of insulin secretion and glucose disposal are as in Table 2.
