Islet Transplantation Improves Peripheral Neuropathy in Patients With Type 1 Diabetes: A 5 Year Prospective Study

Objective: Long-term benefit-risk ratio of islet transplantation remains unclear. We explored the evolution of peripheral and autonomic neuropathy during 5 years after islet transplantation with the Edmonton protocol in type 1 diabetic patients. Patients and Methods: Twenty-one patients (13 islet-al...

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Veröffentlicht in:Transplantation 2013-09, Vol.96, p.217-217
Hauptverfasser: Vantyghem, Marie-Christine, Quintin, Delphine, Karrouz, Wassila, -Francois Hurtevent, Raverdy, Violeta, Caiazzo, Robert, Noel, Christian, Kerr-Conte, Julie, Pattou, Francois
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container_title Transplantation
container_volume 96
creator Vantyghem, Marie-Christine
Quintin, Delphine
Karrouz, Wassila
-Francois Hurtevent
Raverdy, Violeta
Caiazzo, Robert
Noel, Christian
Kerr-Conte, Julie
Pattou, Francois
description Objective: Long-term benefit-risk ratio of islet transplantation remains unclear. We explored the evolution of peripheral and autonomic neuropathy during 5 years after islet transplantation with the Edmonton protocol in type 1 diabetic patients. Patients and Methods: Twenty-one patients (13 islet-alone and 8 islet-after-kidney) were enrolled in this prospective cohort study. Islet transplantation consisted of 2 or 3 sequential infusions with IL2rAb / sirolimus - tacrolimus immunosuppression. All patients underwent biological evaluation, continuous blood pressure and continuous glucose monitoring (CGM), lower -limb electrophysiological testing and cardiovascular autonomic testing (R-R variation with paced breathing, Valsalva ratio, postural heart rate and blood pressure changes) before transplantation and yearly during 5 years. Outcomes were analyzed in intention to treat. Results: At 5 years, islet remained functional in 18 patients (85%). Ten patients (48%) were insulin-independent with a median (IQR) HbA1c at 6.0 (5.86.7) % vs. 7.8 (6.9-8.3) 96 in those requiring insulin (p
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We explored the evolution of peripheral and autonomic neuropathy during 5 years after islet transplantation with the Edmonton protocol in type 1 diabetic patients. Patients and Methods: Twenty-one patients (13 islet-alone and 8 islet-after-kidney) were enrolled in this prospective cohort study. Islet transplantation consisted of 2 or 3 sequential infusions with IL2rAb / sirolimus - tacrolimus immunosuppression. All patients underwent biological evaluation, continuous blood pressure and continuous glucose monitoring (CGM), lower -limb electrophysiological testing and cardiovascular autonomic testing (R-R variation with paced breathing, Valsalva ratio, postural heart rate and blood pressure changes) before transplantation and yearly during 5 years. Outcomes were analyzed in intention to treat. Results: At 5 years, islet remained functional in 18 patients (85%). Ten patients (48%) were insulin-independent with a median (IQR) HbA1c at 6.0 (5.86.7) % vs. 7.8 (6.9-8.3) 96 in those requiring insulin (p<0.001). The medians of sensory action potential (p<0.05) and both sensory and motor nerve conduction velocities (p<0.01) improved between 0 and 5 years. All 4 parameters significantly correlated negatively with mean glucose / CGM and all outcomes except sensory nerve conduction velocity correlated negatively with triglycerides (p[< or =]0.01). Sensory conduction velocity correlated negatively with glucose variability (SD)/ CGM(p<0.01). Tacrolimus levels negatively correlated with motor conduction parameters (p[< or =]0.02). All four parameters correlated positively with ss score or post-prandial C-peptide level (p<0.05). Cardiovascular reflex testing did not change over the 5-year follow-up. Conclusion: islet-alone or after-kidney transplantation improved significantly sensory nerve conduction parameters but not autonomic neuropathy after 5 years. Mean glucose was the main factor associated with this improvement.]]></description><identifier>ISSN: 0041-1337</identifier><language>eng</language><ispartof>Transplantation, 2013-09, Vol.96, p.217-217</ispartof><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780</link.rule.ids></links><search><creatorcontrib>Vantyghem, Marie-Christine</creatorcontrib><creatorcontrib>Quintin, Delphine</creatorcontrib><creatorcontrib>Karrouz, Wassila</creatorcontrib><creatorcontrib>-Francois Hurtevent</creatorcontrib><creatorcontrib>Raverdy, Violeta</creatorcontrib><creatorcontrib>Caiazzo, Robert</creatorcontrib><creatorcontrib>Noel, Christian</creatorcontrib><creatorcontrib>Kerr-Conte, Julie</creatorcontrib><creatorcontrib>Pattou, Francois</creatorcontrib><title>Islet Transplantation Improves Peripheral Neuropathy in Patients With Type 1 Diabetes: A 5 Year Prospective Study</title><title>Transplantation</title><description><![CDATA[Objective: Long-term benefit-risk ratio of islet transplantation remains unclear. We explored the evolution of peripheral and autonomic neuropathy during 5 years after islet transplantation with the Edmonton protocol in type 1 diabetic patients. Patients and Methods: Twenty-one patients (13 islet-alone and 8 islet-after-kidney) were enrolled in this prospective cohort study. Islet transplantation consisted of 2 or 3 sequential infusions with IL2rAb / sirolimus - tacrolimus immunosuppression. All patients underwent biological evaluation, continuous blood pressure and continuous glucose monitoring (CGM), lower -limb electrophysiological testing and cardiovascular autonomic testing (R-R variation with paced breathing, Valsalva ratio, postural heart rate and blood pressure changes) before transplantation and yearly during 5 years. Outcomes were analyzed in intention to treat. Results: At 5 years, islet remained functional in 18 patients (85%). Ten patients (48%) were insulin-independent with a median (IQR) HbA1c at 6.0 (5.86.7) % vs. 7.8 (6.9-8.3) 96 in those requiring insulin (p<0.001). The medians of sensory action potential (p<0.05) and both sensory and motor nerve conduction velocities (p<0.01) improved between 0 and 5 years. All 4 parameters significantly correlated negatively with mean glucose / CGM and all outcomes except sensory nerve conduction velocity correlated negatively with triglycerides (p[< or =]0.01). Sensory conduction velocity correlated negatively with glucose variability (SD)/ CGM(p<0.01). Tacrolimus levels negatively correlated with motor conduction parameters (p[< or =]0.02). All four parameters correlated positively with ss score or post-prandial C-peptide level (p<0.05). Cardiovascular reflex testing did not change over the 5-year follow-up. Conclusion: islet-alone or after-kidney transplantation improved significantly sensory nerve conduction parameters but not autonomic neuropathy after 5 years. 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We explored the evolution of peripheral and autonomic neuropathy during 5 years after islet transplantation with the Edmonton protocol in type 1 diabetic patients. Patients and Methods: Twenty-one patients (13 islet-alone and 8 islet-after-kidney) were enrolled in this prospective cohort study. Islet transplantation consisted of 2 or 3 sequential infusions with IL2rAb / sirolimus - tacrolimus immunosuppression. All patients underwent biological evaluation, continuous blood pressure and continuous glucose monitoring (CGM), lower -limb electrophysiological testing and cardiovascular autonomic testing (R-R variation with paced breathing, Valsalva ratio, postural heart rate and blood pressure changes) before transplantation and yearly during 5 years. Outcomes were analyzed in intention to treat. Results: At 5 years, islet remained functional in 18 patients (85%). Ten patients (48%) were insulin-independent with a median (IQR) HbA1c at 6.0 (5.86.7) % vs. 7.8 (6.9-8.3) 96 in those requiring insulin (p<0.001). The medians of sensory action potential (p<0.05) and both sensory and motor nerve conduction velocities (p<0.01) improved between 0 and 5 years. All 4 parameters significantly correlated negatively with mean glucose / CGM and all outcomes except sensory nerve conduction velocity correlated negatively with triglycerides (p[< or =]0.01). Sensory conduction velocity correlated negatively with glucose variability (SD)/ CGM(p<0.01). Tacrolimus levels negatively correlated with motor conduction parameters (p[< or =]0.02). All four parameters correlated positively with ss score or post-prandial C-peptide level (p<0.05). Cardiovascular reflex testing did not change over the 5-year follow-up. Conclusion: islet-alone or after-kidney transplantation improved significantly sensory nerve conduction parameters but not autonomic neuropathy after 5 years. Mean glucose was the main factor associated with this improvement.]]></abstract></addata></record>
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