Successful Treatment of Brittle Diabetes Following Total Pancreatectomy by Islet Allotransplantation: A Case Report

Angela Koh; Sharleen Imes; Andrew Mark James Shapiro; Peter A Senior

doi:10.6092/1590-8577/1440

Angela Koh Department of Medicine, University of Alberta. Edmonton, AB, Canada
Sharleen Imes Department of Surgery, University of Alberta. Edmonton, AB, Canada
Andrew Mark James Shapiro Clinical Islet Transplant Program, University of Alberta. Edmonton, AB, Canada
Peter A Senior Department of Medicine, University of Alberta. Edmonton, AB, Canada

DOI: https://doi.org/10.6092/1590-8577/1440

Keywords: Hypoglycemia, Islets of Langerhans Transplantation, Pancreatitis, Acute Necrotizing

Abstract

Context Allotransplantation of islets can successfully treat subjects with type 1 diabetes complicated by severe hypoglycemia and erratic glycemic control. Insulin independence is often lost over time due to several factors, including recurrent autoimmunity. Brittle diabetes (frequent hypoglycemia and labile glycemic control) is common after pancreatectomy. This is ameliorated by auto-islet transplantation in pancreatectomized patients who have better glycemic control, even without insulin independence. Case report We herein report a case where islet allotransplantation was carried out in a patient who had undergone total pancreatectomy. Following two islet infusions, he became insulin independent with excellent glycemic control and remains so currently, more than four years after his second islet infusion. Side effects from immunosuppressive therapy were minimal. Discussion Islet allotransplantation can be considered in selected individuals post-pancreatectomy. The absence of autoimmunity may be advantageous for long term graft function relative to islet allotransplantation in type 1 diabetic recipients.

Image: HYPO score and lability index.

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Author Biographies

Angela Koh, Department of Medicine, University of Alberta. Edmonton, AB, Canada

Assistant Professor, Department of Medicine

Sharleen Imes, Department of Surgery, University of Alberta. Edmonton, AB, Canada

Clinical Islet Transplant Program

Andrew Mark James Shapiro, Clinical Islet Transplant Program, University of Alberta. Edmonton, AB, Canada

Professor, Department of Surgery (joint senior author)

Peter A Senior, Department of Medicine, University of Alberta. Edmonton, AB, Canada

Associate Professor, Department of Medicine (joint senior author)

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