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Parajuli S, Tamburrini R, Aziz F, Dodin B, Astor BC, Mandelbrot D, Kaufman D, Odorico J. Simultaneous Pancreas-Kidney Transplant Outcomes Stratified by Autoantibodies Status and Pretransplant Fasting C-peptide. Transplant Direct 2024; 10:e1721. [PMID: 39399059 PMCID: PMC11469883 DOI: 10.1097/txd.0000000000001721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 08/26/2024] [Accepted: 09/04/2024] [Indexed: 10/15/2024] Open
Abstract
BACKGROUNDS Pancreatic beta cell function and islet autoantibodies classically distinguish types of diabetes (type 1 diabetes mellitus [DM] or type 2 DM). Here, we sought to evaluate simultaneous pancreas-kidney (SPK) transplant outcomes stratified by the presence or absence of beta cell function and autoantibodies. METHODS SPK recipients were eligible if pretransplant autoantibodies were measured against insulin, islet cell, or glutamic acid decarboxylase 65-kD isoform. Recipients were categorized as A+ or A- based on the detection of ≥1 autoantibodies. Recipients were similarly categorized on the basis of detectable pretransplant fasting C-peptide of ≥2 ng/mL (β+) or <2 ng/mL (β-). Thus, recipients were categorized into 4 groups: A+β-, A-β-, A-β+, and A+β+. Outcomes of interest were overall pancreas graft failure (non-death-censored), death-censored pancreas, or kidney graft failure (death-censored pancreas graft failure [DCGF]; kidney DCGF), composite outcomes with any of the 3 outcomes as pancreas DCGF, use of an antidiabetic agent, or hemoglobin A1c >6.5. RESULTS One hundred eighty-three SPK recipients were included: A+β- (n = 72), A-β- (n = 42), A-β+ (n = 49), and A+β+ (n = 20). We did not detect a statistical difference in non-death-censored pancreas graft failure for A+β- recipients compared with other groups: A-β- (adjusted hazard ratio [aHR]: 0.44; 95% confidence interval [CI], 0.14-1.42), A-β+ (aHR: 1.02; 95% CI, 0.37-2.85), and A+β+ (aHR: 0.67; 95% CI, 0.13-3.33) in adjusted analyses. Similar outcomes were observed for other outcomes. CONCLUSIONS In SPK recipients, outcomes were similar among recipients with classic features of type 1 DM and various other types of DM.
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Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Riccardo Tamburrini
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ban Dodin
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Brad C. Astor
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Didier Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dixon Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jon Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
- University of Wisconsin Health Transplant Center, Madison, WI
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Anteby R, Lucander A, Bachul PJ, Pyda J, Grybowski D, Basto L, Generette GS, Perea L, Golab K, Wang LJ, Tibudan M, Thomas C, Fung J, Witkowski P. Evaluating the Prognostic Value of Islet Autoantibody Monitoring in Islet Transplant Recipients with Long-Standing Type 1 Diabetes Mellitus. J Clin Med 2021; 10:jcm10122708. [PMID: 34205321 PMCID: PMC8233942 DOI: 10.3390/jcm10122708] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 12/03/2022] Open
Abstract
(1) Background: The correlation between titers of islet autoantibodies (IAbs) and the loss of transplanted islets remains controversial. We sought to evaluate the prognostic utility of monitoring IAbs in diabetic patients after islet transplantation (ITx); (2) Methods: Twelve patients with Type 1 diabetes mellitus and severe hypoglycemia underwent ITx. Serum concentration of glutamic acid decarboxylase (GAD), insulinoma antigen 2 (IA-2), and zinc transport 8 (ZnT8) autoantibodies was assessed before ITx and 0, 7, and 75 days and every 3 months post-operatively; (3) Results: IA-2A (IA-2 antibody) and ZnT8A (ZnT8 antibody) levels were not detectable before or after ITx in all patients (median follow-up of 53 months (range 24–61)). Prior to ITx, GAD antibody (GADA) was undetectable in 67% (8/12) of patients. Of those, 75% (6/8) converted to GADA+ after ITx. In 67% (4/6) of patients with GADA+ seroconversion, GADA level peaked within 3 months after ITx and subsequently declined. All patients with GADA+ seroconversion maintained long-term partial or complete islet function (insulin independence) after 1 or 2 ITx. There was no correlation between the presence of IAb-associated HLA haplotypes and the presence of IAbs before or after ITx; (4) Conclusions: There is no association between serum GADA trends and ITx outcomes. IA-2A and ZnT8A were not detectable in any of our patients before or after ITx.
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Affiliation(s)
- Roi Anteby
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Harvard School of Public Health, Boston, MA 02115, USA
| | - Aaron Lucander
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA
| | - Piotr J. Bachul
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Jordan Pyda
- Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA;
| | - Damian Grybowski
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Lindsay Basto
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Gabriela S. Generette
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Laurencia Perea
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Karolina Golab
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Ling-jia Wang
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Martin Tibudan
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Celeste Thomas
- Department of Medicine, The University of Chicago, Chicago, IL 60637, USA;
| | - John Fung
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
| | - Piotr Witkowski
- Department of Surgery, The University of Chicago, Chicago, IL 60637, USA; (R.A.); (A.L.); (P.J.B.); (D.G.); (L.B.); (G.S.G.); (L.P.); (K.G.); (L.-j.W.); (M.T.); (J.F.)
- Correspondence: ; Tel.: +1-773-702-2447
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