206-LB: Survival after Islet Transplantation in Subjects with Type 1 Diabetes: 20-Year Follow-Up

Type 1 diabetes (T1D) is associated with premature mortality due to T1D-related acute and chronic complications, including severe hypoglycemic events (SHE), cardiovascular (CVD) and renal disease. Islet transplantation (ITx) has been shown to provide near-normal glycemic control and protection from SHEs in a select group of patients with T1D. We retrospectively evaluated the survival of ITx recipients (n= 49) followed up to 20 years. Subjects were transplanted and followed from 2000-2020 at our institution. Study cohort included 29 females (59.2%). Median age at T1D diagnosis was 13.2 (6.7 - 20.0) years while mean age and median duration of T1D at ITx was 42.8 ± 8.3 years and 29.5 (17.2 - 38.2) years, respectively. Two subjects (4.08%) died during follow-up. Duration of graft function was 4.4 (1.3 - 12.2) years. Cumulative survival post-ITx was 100%, 96% and 85%, at 10, 15 and 20 years follow-up, respectively. Results suggest that despite chronic immunosuppression, near-normal metabolic control achieved following ITx can reduce the increased mortality risk associated with T1D. Possible factors accounting for these results include lower cumulative hyperglycemic exposure and prevention of SHE. Subjects selected for ITx represent a highly vulnerable group at risk of recurrent SHE and death. ITx may prevent mortality by preventing SHE and reducing CVD risk factors in selected patients with T1D.