Autoimmune Diabetes Recurrence After Pancreas Transplantation: Diagnosis, Management, and Literature Review
María Argente-Pla, Antonio Martínez-Millana, María Isabel Del Olmo-García, Jordi Espí-Reig, Judith Pérez-Rojas, Vicente Traver-Salcedo, Juan Francisco Merino-Torres
(Department of Endocrinology and Nutrition, La Fe University and Polytechnic Hospital, Valencia, Spain)
Ann Transplant 2019; 24:608-616
Pancreas transplantation can be a viable treatment option for patients with type 1 diabetes mellitus (T1DM), especially for those who are candidates for kidney transplantation. T1DM may rarely recur after pancreas transplantation, causing the loss of pancreatic graft. The aim of this study was to describe the prevalence of T1DM recurrence after pancreas transplantation in our series.
MATERIAL AND METHODS: Eighty-one patients transplanted from 2002 to 2015 were included. Autoantibody testing (GADA and IA-2) was performed before pancreas transplantation and during the follow-up.
RESULTS: The series includes 48 males and 33 females, mean age 37.4±5.7 years and mean duration of diabetes 25.5±6.5 years. Patients received simultaneous pancreas kidney (SPK) transplantation. After SPK transplantation, 56 patients retained pancreatic graft, 8 patients died, and 17 patients lost their pancreatic graft. T1DM recurrence occurred in 2 of the 81 transplanted patients, yielding a prevalence of 2.5%, with an average time of appearance of 3.3 years after transplant. Pancreatic enzymes were normal in the 2 patients, ruling out pancreatic rejection. T1DM recurrence was confirmed histologically, showing selective lymphoid infiltration of the pancreatic islets.
CONCLUSIONS: T1DM recurrence after pancreas transplantation is infrequent; however, it is one of the causes of pancreatic graft loss that should always be ruled out. Negative autoimmunity prior to transplantation does not ensure that T1DM does not recur.
Keywords: Autoantibodies, Autoimmunity, Diabetes Mellitus, Type 1, Immunosuppression, Pancreas Transplantation