Diabetes care · 2016
HLA-A*24 Carrier Status and Autoantibody Surges Posttransplantation Associate With Poor Functional Outcome in Recipients of an Islet Allograft.
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Demeester Simke, Balke Else M, Van der Auwera Bart J, Gillard Pieter, Hilbrands Robert, Lee DaHae, Van de Velde Ursule, Ling Zhidong, Roep Bart O, Pipeleers Daniel G, Gorus Frans K, Keymeulen Bart
Аннотация
OBJECTIVE: We investigated whether changes in islet autoantibody profile and presence of HLA risk markers, reported to predict rapid β-cell loss in pre-type 1 diabetes, associate with poor functional outcome in islet allograft recipients.
RESEARCH DESIGN AND METHODS: Forty-one patients received ≥2.3 million β-cells/kg body wt in one to two intraportal implantations. Outcome after 6-18 months was assessed by C-peptide (random and stimulated), insulin dose, and HbA1c.
RESULTS: Patients carrying HLA-A*24-positive or experiencing a significant autoantibody surge within 6 months after the first transplantation (n = 19) had lower C-peptide levels (P ≤ 0.003) and higher insulin needs (P < 0.001) despite higher HbA1c levels (P ≤ 0.018). They became less often insulin independent (16% vs. 68%, P = 0.002) and remained less often C-peptide positive (47% vs. 100%, P < 0.001) than recipients lacking both risk factors. HLA-A*24 positivity or an autoantibody surge predicted insulin dependence (P = 0.007).
CONCLUSIONS: HLA-A*24 and early autoantibody surge after islet implantation associate with poor functional graft outcome.
RESEARCH DESIGN AND METHODS: Forty-one patients received ≥2.3 million β-cells/kg body wt in one to two intraportal implantations. Outcome after 6-18 months was assessed by C-peptide (random and stimulated), insulin dose, and HbA1c.
RESULTS: Patients carrying HLA-A*24-positive or experiencing a significant autoantibody surge within 6 months after the first transplantation (n = 19) had lower C-peptide levels (P ≤ 0.003) and higher insulin needs (P < 0.001) despite higher HbA1c levels (P ≤ 0.018). They became less often insulin independent (16% vs. 68%, P = 0.002) and remained less often C-peptide positive (47% vs. 100%, P < 0.001) than recipients lacking both risk factors. HLA-A*24 positivity or an autoantibody surge predicted insulin dependence (P = 0.007).
CONCLUSIONS: HLA-A*24 and early autoantibody surge after islet implantation associate with poor functional graft outcome.
Предметные рубрики MeSH
AdultAllograftsAutoantibodiesC-PeptideCation Transport ProteinsDiabetes Mellitus, Type 1FemaleGlutamate DecarboxylaseHLA-A24 AntigenHumansHypoglycemic AgentsInsulinInsulin-Secreting CellsIslets of Langerhans TransplantationMaleMiddle AgedTransplantation, HomologousTreatment OutcomeZinc Transporter 8