TY - JOUR
T1 - Chronic Pancreas Allograft Rejection Followed by Successful HLA-Incompatible Islet Alloautotransplantation
T2 - A Novel Strategy?
AU - Veltkamp, Denise M. J.
AU - Nijhoff, Michiel F.
AU - van den Broek, Dennis A. J.
AU - Buntinx, Maren
AU - Kers, Jesper
AU - Engelse, Marten A.
AU - Huurman, Volkert A. L.
AU - Roelen, Dave L.
AU - Heidt, Sebastiaan
AU - Alwayn, Ian P. J.
AU - de Koning, Eelco J. P.
AU - de Vries, Aiko P. J.
N1 - Publisher Copyright: Copyright © 2023 Veltkamp, Nijhoff, van den Broek, Buntinx, Kers, Engelse, Huurman, Roelen, Heidt, Alwayn, de Koning and de Vries.
PY - 2023
Y1 - 2023
N2 - The purpose of pancreas or islet transplantation is to restore glycemic control in order to mitigate diabetes-related complications and prevent severe hypoglycemia. Complications from chronic pancreas allograft rejection may lead to transplantectomy, even when the endocrine function remains preserved. We present first evidence of a successful HLA incompatible islet re-transplantation with islets isolated from a rejecting pancreas allograft after simultaneous kidney pancreas transplantation. The pancreas allograft was removed because of progressively painful pancreatic panniculitis from clinically uncontrolled chronic rejection. The endocrine function was preserved. Induction treatment for this “islet alloautotransplantation” consisted of plasmapheresis, IVIg and alemtuzumab. At 1 year, the patient retained islet graft function with good glycemic control and absence of severe hypoglycemia, despite persistent low-grade HLA donor-specific antibodies. His panniculitis had resolved completely. In our point of view, islet alloautotransplantation derived from a chronically rejecting pancreas allograft is a potential option to salvage (partial) islet function, despite preformed donor-specific antibodies, in order to maintain stable glycemic control. Thereby it protects against severe hypoglycemia, and it potentially mitigates kidney graft dysfunction and other diabetes-related complications in patients with continued need for immunosuppression and who are otherwise difficult to retransplant.
AB - The purpose of pancreas or islet transplantation is to restore glycemic control in order to mitigate diabetes-related complications and prevent severe hypoglycemia. Complications from chronic pancreas allograft rejection may lead to transplantectomy, even when the endocrine function remains preserved. We present first evidence of a successful HLA incompatible islet re-transplantation with islets isolated from a rejecting pancreas allograft after simultaneous kidney pancreas transplantation. The pancreas allograft was removed because of progressively painful pancreatic panniculitis from clinically uncontrolled chronic rejection. The endocrine function was preserved. Induction treatment for this “islet alloautotransplantation” consisted of plasmapheresis, IVIg and alemtuzumab. At 1 year, the patient retained islet graft function with good glycemic control and absence of severe hypoglycemia, despite persistent low-grade HLA donor-specific antibodies. His panniculitis had resolved completely. In our point of view, islet alloautotransplantation derived from a chronically rejecting pancreas allograft is a potential option to salvage (partial) islet function, despite preformed donor-specific antibodies, in order to maintain stable glycemic control. Thereby it protects against severe hypoglycemia, and it potentially mitigates kidney graft dysfunction and other diabetes-related complications in patients with continued need for immunosuppression and who are otherwise difficult to retransplant.
KW - antibody-mediated rejection
KW - donor specific antigen (DSA)
KW - islet transplantation
KW - re-transplantation
KW - simultaneous kidney pancreas transplantation
UR - http://www.scopus.com/inward/record.url?scp=85170381059&partnerID=8YFLogxK
U2 - https://doi.org/10.3389/ti.2023.11505
DO - https://doi.org/10.3389/ti.2023.11505
M3 - Article
C2 - 37692453
SN - 0934-0874
VL - 36
JO - Transplant international
JF - Transplant international
M1 - 11505
ER -