Pancreas transplantation is an important option to those with diabetes. Survival rates and number of pancreas transplants have improved with the advent of newer immunosuppressive agents (tacrolimus and mycophenolate). The median survival for pancreas transplants was approximately 9 years (10 years for SPK recipients). However, at 21-years the survival rate was < 10%. In all, the long-term success of pancreas transplants still has room for improvement. And with a new surge to look for HLA antibodies (8) and potentially to treat or prevent their development, there is hope that survival over the next 20 years will be much improved.
[Show abstract][Hide abstract] ABSTRACT: Type 1 diabetes (T1D) is one of the major autoimmune diseases affecting children and young adults worldwide. To date, the different immunotherapies tested have achieved insulin independence in <5% of treated individuals. Recently, a novel hematopoietic stem cell (HSC)-based strategy has been tested in individuals with new-onset T1D. The aim of this study was to determine the effects of autologous nonmyeloablative HSC transplantation in 65 individuals with new-onset T1D who were enrolled in two Chinese centers and one Polish center, pooled, and followed up for 48 months. A total of 59% of individuals with T1D achieved insulin independence within the first 6 months after receiving conditioning immunosuppression therapy (with antithymocyte globulin and cyclophosphamide) and a single infusion of autologous HSCs, and 32% remained insulin independent at the last time point of their follow-up. All treated subjects showed a decrease in HbA1c levels and an increase in C-peptide levels compared with pretreatment. Despite a complete immune system recovery (i.e., leukocyte count) after treatment, 52% of treated individuals experienced adverse effects. Our study suggests the following: 1) that remission of T1D is possible by combining HSC transplantation and immunosuppression; 2) that autologous nonmyeloablative HSC transplantation represents an effective treatment for selected individuals with T1D; and 3) that safer HSC-based therapeutic options are required.
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