Development of Autoimmune-Mediated β Cell Failure After Total Pancreatectomy With Autologous Islet Transplantation

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
M D BellinT B Dunn

Abstract

Total pancreatectomy with islet autotransplantation (TPIAT) is performed for definitive treatment of chronic pancreatitis; patients are not diabetic before surgery, or have C-peptide positive pancreatogenous diabetes. Thus, TPIAT recipients are not traditionally considered at risk for autoimmune loss of the islet graft. We describe a 43-year-old female who underwent TPIAT with high mass islet graft of 6031 IEQ/kg, with no evidence of presurgical β cell autoimmunity who developed type 1 diabetes within the first year after TPIAT, resulting in complete loss of beta cell function. The patient had positive GAD and insulin autoantibodies at 1 year and 18 months after TPIAT, not present prior, and undetectable C-peptide after mixed meal and intravenous glucose tolerance testing at 18 months. Glucagon secretion was preserved, suggesting the transplanted alpha cell mass was intact. HLA typing revealed a DR3/DR4 class II haplotype. This case highlights the need to consider de novo type 1 diabetes in patients with unexpected islet graft failure after TPIAT.

References

Dec 24, 2008·Transplantation·David E R SutherlandBernhard J Hering
Aug 21, 2010·Endocrinology and Metabolism Clinics of North America·Ezio Bonifacio, Anette G Ziegler
Jun 11, 2011·Current Diabetes Reports·George W BurkeAlberto Pugliese
Mar 9, 2012·Journal of the American College of Surgeons·David E R SutherlandTimothy L Pruett
Jul 11, 2012·Current Diabetes Reports·Melena D BellinDavid E R Sutherland
Jul 31, 2013·Lancet·Mark A AtkinsonAaron W Michels

❮ Previous
Next ❯

Citations

Nov 5, 2015·Current Opinion in Organ Transplantation·Ty B DunnMelena D Bellin
Jul 28, 2016·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·M D BellinA Moran
Jul 21, 2017·Current Diabetes Reports·Valeria SordiLorenzo Piemonti
Dec 15, 2020·Pancreatology : Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]·Harmeet K KharoudMelena D Bellin
Jul 3, 2021·Journal of Clinical Medicine·Beata Jabłońska, Sławomir Mrowiec

❮ Previous
Next ❯

Related Concepts

Related Feeds

Autoimmune Diabetes & Tolerance

Patients with type I diabetes lack insulin-producing beta cells due to the loss of immunological tolerance and autoimmune disease. Discover the latest research on targeting tolerance to prevent diabetes.

Allogenic & Autologous Therapies

Allogenic therapies are generated in large batches from unrelated donor tissues such as bone marrow. In contrast, autologous therapies are manufactures as a single lot from the patient being treated. Here is the latest research on allogenic and autologous therapies.

Autoimmune Diseases

Autoimmune diseases occur as a result of an attack by the immune system on the body’s own tissues resulting in damage and dysfunction. There are different types of autoimmune diseases, in which there is a complex and unknown interaction between genetics and the environment. Discover the latest research on autoimmune diseases here.