IPITA 2013 Abstracts Supplement

Abstract

Objective: Long-term benefit-risk ratio of islet transplantation rem unclear. We explored the evolution of peripheral and autonomic ne pathy during 5 years after islet transplantation with the Edmonton pr col in type 1 diabetic patients. Patients and Methods: Twenty-one patients (13 islet-alone 8 islet-after-kidney) were enrolled in this prospective cohort study. transplantation consisted of 2 or 3 sequential infusions with IL2r sirolimus tacrolimus immunosuppression. All patients underwent logical evaluation, continuous blood pressure and continuous gluc monitoring (CGM), lower-limb electrophysiological testing and car vascular autonomic testing (R-R variation with paced breathing, Vals ratio, postural heart rate and blood pressure changes) before transp tation and yearly during 5 years. Outcomes were analyzed in inten to treat. Results: At 5 years, islet remained functional in 18 patients (85 Ten patients (48%) were insulin-independent with a median (I HbA1c at 6.0 (5.8–6.7) % vs. 7.8 (6.9-8.3) % in those requiring ins (p<0.001). The medians of sensory action potential (p<0.05) and sensory and motor nerve conduction velocities (p<0.01) improved tween 0 and 5 years. All 4 parameters significantly correlated negati with mean glucose / CGM and all outcomes except sensory nerve duction velocity correlated negatively with triglycerides (p≤0.01). S sory conduction velocity correlated negatively with glucose variab (SD) / CGM (p<0.01). Tacrolimus levels negatively correlated with m conduction parameters (p≤0.02). All four parameters correlated p tively with ß score or post-prandial C-peptide level (p<0.05). Cardio cular reflex testing did not change over the 5–year follow-up. Conclusion: islet-alone or after-kidney transplantation improved nificantly sensory nerve conduction parameters but not autonomic n ropathy after 5 years. Mean glucose was the main factor associated this improvement. (ClinicalTrial.gov: NCT00446264 / NCT01123187).