Australian Islet Transplant Consortium. Royal Adelaide Hospital. PT Coates, D Cooke, C Drogemuller, C Mee, D. Mohanasundaram C Milner, S Prasad, T Radford, G Russ, C Russell, D Torpy.
Multicenter Australian Trial of Islet Transplantation: Improving Accessibility and Outcomes
Article first published online: 13 MAY 2013
© Copyright 2013 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 13, Issue 7, pages 1850–1858, July 2013
How to Cite
O'Connell, P. J., Holmes-Walker, D. J., Goodman, D., Hawthorne, W. J., Loudovaris, T., Gunton, J. E., Thomas, H. E., Grey, S. T., Drogemuller, C. J., Ward, G. M., Torpy, D. J., Coates, P. T., Kay, T. W. and On behalf of the Australian Islet Transplant Consortium (2013), Multicenter Australian Trial of Islet Transplantation: Improving Accessibility and Outcomes. American Journal of Transplantation, 13: 1850–1858. doi: 10.1111/ajt.12250
Childrens Hospital Westmead. SI Alexander
The Garvin Institute of Medical Research. S Grey, D Liuwantara, JE Gunton
St Vincent's Hospital and Medical Research Institute. P Campbell, J Chee, S Fynch, M Fink, D Goodman, K Howe, C Hurburgh, F Ierino, A Jenkins, G Jhala, T Kay, B Krishnamurthy, T Loudovaris, S Mannering, L Mariana, Z Mollah, E Premaratne, V Stevenson, H Thomas, A Thorburn, J Vrazas, G Ward, Y Zhao
University of Sydney at Westmead Hospital. P Anderson, J Chapman, S Davies, J George, JE Gunton, W Hawthorne, DJ Holmes-Walker, M Hu, E Jaminez, V Lam, B Nankivell, P O'Connell, A Patel, P Phillips, H Pleass, B Ryan, P Robertson, L Yuen, L Williams, J Wu, S Yi.
- Issue published online: 26 JUN 2013
- Article first published online: 13 MAY 2013
- Manuscript Revised: 14 MAR 2013
- Manuscript Accepted: 14 MAR 2013
- Manuscript Received: 17 JAN 2013
- Antithymocyte globulin (ATG);
- graft function;
- insulin independence;
Whilst initial rates of insulin independence following islet transplantation are encouraging, long-term function using the Edmonton Protocol remains a concern. The aim of this single-arm, multicenter study was to evaluate an immunosuppressive protocol of initial antithymocyte globulin (ATG), tacrolimus and mycophenolate mofetil (MMF) followed by switching to sirolimus and MMF. Islets were cultured for 24 h prior to transplantation. The primary end-point was an HbA1c of <7% and cessation of severe hypoglycemia. Seventeen recipients were followed for ≥12 months. Nine islet preparations were transported interstate for transplantation. Similar outcomes were achieved at all three centers. Fourteen of the 17 (82%) recipients achieved the primary end-point. Nine (53%) recipients achieved insulin independence for a median of 26 months (range 7–39 months) and 6 (35%) remain insulin independent. All recipients were C-peptide positive for at least 3 months. All subjects with unstimulated C-peptide >0.2 nmol/L had cessation of severe hypoglycemia. Nine of the 17 recipients tolerated switching from tacrolimus to sirolimus with similar graft outcomes. There was a small but significant reduction in renal function in the first 12 months. The combination of islet culture, ATG, tacrolimus and MMF is a viable alternative for islet transplantation.