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Diabetes Metab. 2018 Sep 14. pii: S1262-3636(18)30168-X. doi: 10.1016/j.diabet.2018.07.006. [Epub ahead of print]

Indications for islet or pancreatic transplantation: Statement of the TREPID working group on behalf of the Société francophone du diabète (SFD), Société francaise d'endocrinologie (SFE), Société francophone de transplantation (SFT) and Société française de néphrologie - dialyse - transplantation (SFNDT).

Author information

1
Department of endocrinology, diabetes and nutrition, university hospital of Montpellier, Lapeyronie hospital, laboratory of cell therapy for diabetes (LTCD), institute of regenerative medicine and biotherapy, (IRMB), university hospital of Montpellier, Saint-Éloi, hospital, IGF, CNRS UMR5203, Inserm U1191, Montpellier university, 34094 Montpellier, France.
2
Urology department, CHU de Nantes, centre de recherche en transplantation et immunologie, UMR 1064, Inserm, université de Nantes, institut de transplantation urologie néphrologie (ITUN), Nantes, France.
3
Department of nephrology, 38000 Toulouse, France.
4
Hospices civils de Lyon, service d'urologie et de chirurgie de la transplantation, pôle Chirurgie, 69000 Lyon, France.
5
Hospices civils de Lyon, service d'urologie et de chirurgie de la transplantation, pôle Chirurgie, 69000 Lyon, France; Inserm, U1055, 38000 Grenoble, France.
6
University of Lille, Inserm, CHU de Lille, UMR 1190, translational research in diabetes, endocrine surgery, 59000 Lille, France; CHU Lille, endocrine surgery, 59000 Lille, France.
7
Department of Endocrinology and Diabetology, University Hospital of Strasbourg, 67000 Strasbourg, France; INSERM UMR 1260, Regenerative Nanomedecine, Federation of Translational Medicine, University of Strasbourg, 67000 Strasbourg, France.
8
Division of Transplantation, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland.
9
Department of Endocrinology, Pôle DigiDune, Grenoble University Hospital, Grenoble Alpes University, 38000 Grenoble, France; Grenoble Alpes University, LBFA, 38000, Grenoble, France.
10
University of Lille, Inserm, CHU de Lille, UMR 1190, translational research in diabetes, endocrine surgery, 59000 Lille, France; CHU Lille, Endocrinology, diabetology and metabolism, 59000 Lille, France. Electronic address: mc-vantyghem@chru-lille.fr.

Abstract

While either pancreas or pancreatic islet transplantation can restore endogenous insulin secretion in patients with diabetes, no beta-cell replacement strategies are recommended in the literature. For this reason, the aim of this national expert panel statement is to provide information on the different kinds of beta-cell replacement, their benefit-risk ratios and indications for each type of transplantation, according to type of diabetes, its control and association with end-stage renal disease. Allotransplantation requires immunosuppression, a risk that should be weighed against the risks of poor glycaemic control, diabetic lability and severe hypoglycaemia, especially in cases of unawareness. Pancreas transplantation is associated with improvement in diabetic micro- and macro-angiopathy, but has the associated morbidity of major surgery. Islet transplantation is a minimally invasive radiological or mini-surgical procedure involving infusion of purified islets via the hepatic portal vein, but needs to be repeated two or three times to achieve insulin independence and long-term functionality. Simultaneous pancreas-kidney and pancreas after kidney transplantations should be proposed for kidney recipients with type 1 diabetes with no surgical, especially cardiovascular, contraindications. In cases of high surgical risk, islet after or simultaneously with kidney transplantation may be proposed. Pancreas, or more often islet, transplantation alone is appropriate for non-uraemic patients with labile diabetes. Various factors influencing the therapeutic strategy are also detailed in this report.

KEYWORDS:

Cell therapy; Diabetes; Islet transplantation; Kidney transplantation; Pancreas transplantation; Type 1 diabetes

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