Islets allotransplantations in Poland – case report of the patient with type I diabetes after kidney transplantation

Backgprund: Diabetes is a growing problem in developed countries. The aim of the study was to asses results of the first Polish islets allotransplantations in patients with type I diabetes and after kidney transplantation.
Case Report: Islets transplantation was performed on the 12[sup]th[/sup] of June 2008.
Patient: 39-years old female with type I diabetes since 1984. Since 2003 on
haemodialysis treatment. In March 2007 the kidney transplantation had been
performed. Before islets transplantation: Fasting c-peptide was 0.06 ng/ml,
stimulated c-peptide was 0.21 ng/ml. HBA1C was 7.2 mg%. Daily insulin intake was 76 U (1.3 U/kg/ per day). Patient kept weight between 55-58 kg (BMI 20.5-21.5 kg/m2) Within last 6 months, before islets infusion, episodes of hypoglycaemia were present 6 times (3 times at night).
Results: HLA matching did not reveal incompatibility, cross-match was negative. After islets allotransplantation patient received antibiotics and anticoagulation prophylaxis. Immunosuppression consisted of: Tacrolimus, CellCept, steroids in low doses and Basiliximab. Function of the transplanted kidneys was stable - creatinine level - 1.0-1.6 mg/dl, clearance of creatinine - 55 ml/kg/min. C-peptide at: 3, 14, 30, 90 and 240 days after islets transplantation was respectively: 1.02; 0.39; 0.79; 0.21; 0.39 ng/ml. Stimulated c-peptide 240 days after islets transplantation was 0.69 ng/ml. Daily insulin intake at 3, 14, 30, 90 and 240 days after islets transplantation was respectively: 48U, 38U, 30U, 50U, 39U. HBA1C at 90 and 240 days after islets transplantation was: 5.9 and 6.0 mg/dl. Due to recent subclinical rejection found in kidney's biopsy, steroids withdrawal was impossible. Qualification for another islets infusion had been stopped.
Conclusions: Islets transplantation is a safe method which allows for better
diabetic control and lower daily insulin intake. In some cases it is possible to
give another islet infusion in order to receive full insulin-independence.

Keywords: case report, clinical outcome