Treating diabetes with islet transplantation: Lessons from the past decade in Lille

被引:34
作者
Vantyghem, M. -C. [1 ,2 ]
Defrance, F. [1 ]
Quintin, D. [1 ]
Leroy, C. [1 ]
Raverdi, V. [3 ]
Prevost, G. [4 ]
Caiazzo, R. [3 ]
Kerr-Conte, J. [2 ]
Glowacki, F. [5 ]
Hazzan, M. [5 ]
Noel, C. [5 ]
Diamenord, F. Pattou [2 ,3 ]
Balavoine, A. S. [6 ]
Bresson, R. [7 ]
Bourdelle-Hego, M. F. [8 ]
Cazaubiel, M. [6 ]
Cordonnier, M. [9 ]
Delefosse, D. [10 ]
Dorey, F. [9 ]
Fayard, A. [10 ]
Fermon, C. [11 ]
Fontaine, P. [12 ]
Gillot, C. [7 ]
Haye, S. [13 ]
Le Guillou, A. C. [12 ]
Karrouz, W. [14 ]
Lemaire, C. [7 ]
Lepeut, M. [11 ]
Leroy, R. [13 ]
Mycinski, B. [15 ]
Parent, E. [6 ]
Siame, C. [13 ]
Sterkers, A. [16 ]
Torres, F. [16 ]
Verier-Mine, O. [9 ]
Verlet, E. [17 ]
Desailloud, R. [18 ]
Duerrbach, A. [19 ]
Godin, M. [20 ]
Lalau, J. D. [18 ]
Lukas-Croisier, C. [21 ]
Thervet, E. [22 ]
Toupance, O. [23 ]
Reznik, Y. [24 ]
Westeel, P. F. [25 ]
机构
[1] Lille Univ Hosp, C Huriez Hosp, Dept Endocrinol & Metab, INSERM,U599, 1 Rue Polonovski, F-59037 Lille, France
[2] Lille Univ Hosp, INSERM, U859, F-59037 Lille, France
[3] Lille Univ Hosp, Dept Endocrine Surg, F-59037 Lille, France
[4] Rouen Univ Hosp, Dept Endocrinol, Rouen, France
[5] Lille Univ Hosp, Dept Nephrol, F-59037 Lille, France
[6] Tourcoing Gen Hosp, Diabetol Dept, Tourcoing, France
[7] Douai Gen Hosp, Diabetol Dept, Douai, France
[8] Bethune Gen Hosp, Diabetol Dept, Bethune, France
[9] Valenciennes Gen Hosp, Diabetol Hosp, Valenciennes, France
[10] Arras Gen Hosp, Diabetol Dept, Arras, France
[11] Roubaix Gen Hosp, Diabetol Dept, Roubaix, France
[12] Lille Univ Hosp, Diabetol Dept, F-59037 Lille, France
[13] Clin La Louviere, La Louviere, France
[14] Lille Univ Hosp, Dept Endocrinol, Lille, France
[15] Calais Gen Hosp, Diabetol Dept, Calais, France
[16] Lille Univ Hosp, Dept Endocrine Surg, F-59037 Lille, France
[17] Dunkerque Gen Hosp, Diabetol Dept, Dunkerque, France
[18] Amiens Univ Hosp, Dept Endocrinol, Amiens, France
[19] Univ Paris 11, Isleplzrol Unit, INSERM, UMR 1014,Univ Hosp Bicetre, Le Kremlin Bicetre, France
[20] Rouen Univ Hosp, Nephrol Unit, Rouen, France
[21] Reims Univ Hosp, Endocrine Dept, Reims, France
[22] Univ Paris 05, G Pompidou European Hosp, Nephrol Unit, INSERM,UMR 5775,HYPPARC Dept, Paris, France
[23] Univ Hosp Reims, Nephrol Unit, Reims, France
[24] Cote de Nacre Univ Hosp, Dept Endocrinol, Caen, France
[25] Amiens Univ Hosp, Dept Nephrol, Amiens, France
关键词
Islet transplantation; Diabetes cell therapy; Beta score; Brittle diabetes; Type; 1; diabetes; STEROID-FREE IMMUNOSUPPRESSION; QUALITY-OF-LIFE; CELL TRANSPLANTATION; KIDNEY-TRANSPLANTATION; FOLLOW-UP; INSULIN-SECRETION; METABOLIC-CONTROL; GRAFT FUNCTION; SINGLE-DONOR; TYPE-1;
D O I
10.1016/j.diabet.2013.10.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Type 1 diabetes (T1D) is due to the loss of both beta-cell insulin secretion and glucose sensing, leading to glucose variability and a lack of predictability, a daily issue for patients. Guidelines for the treatment of T1D have become stricter as results from the Diabetes Control and Complications Trial (DCCT) demonstrated the close relationship between microangiopathy and HbA1c levels. In this regard, glucometers, ambulatory continuous glucose monitoring, and subcutaneous and intraperitoneal pumps have been major developments in the management of glucose imbalance. Besides this technological approach, islet transplantation (IT) has emerged as an acceptable safe procedure with results that continue to improve. Research in the last decade of the 20th century focused on the feasibility of islet isolation and transplantation and, since 2000, the success and reproducibility of the Edmonton protocol have been proven, and the mid-term (5-year) benefit risk ratio evaluated. Currently, a 5-year 50% rate of insulin independence can be expected, with stabilization of microangiopathy and macroangiopathy, but the possible side-effects of immunosuppressants, limited availability of islets and still limited duration of insulin independence restrict the procedure to cases of brittle diabetes in patients who are not overweight or have no associated insulin resistance. However, various prognostic factors have been identified that may extend islet graft survival and reduce the number of islet injections required; these include graft quality, autoimmunity, immunosuppressant regimen and non-specific inflammatory reactions. Finally, alternative injection sites and unlimited sources of islets are likely to make IT a routine procedure in the future. (C) 2013 Elsevier Masson SAS. All rights reserved.
引用
收藏
页码:108 / 119
页数:12
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