scholarly journals P1049LOWER ACCEPTANCE RATE FOR PANCREAS OR ISLET TRANSPLANTATION AFTER INTRODUCTION OF A MULTIDISCIPLINARY APPROACH FOR TRANSPLANT ELIGIBILITY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Espen Nordheim ◽  
Jørn Petter Lindal ◽  
Espen Nordheim ◽  
Anders Åsberg ◽  
Kåre Birkeland ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Islet Transplantation ◽  
Outpatient Clinic ◽  
Multidisciplinary Team ◽  
Multidisciplinary Approach ◽  
Cell Replacement Therapy ◽  
Β Cell ◽  
P Values ◽  
Cell Replacement ◽  
Before And After

Abstract Background and Aims β-cell replacement therapy, with either pancreas or islet transplantation, is a treatment option for selected patients with brittle type 1 diabetes. All patients referred to the national transplant centre for assessment of this treatment, are evaluated in the outpatient clinic before any work-up for transplantation is initiated. Before 2015, this assessment was performed by a nephrologist alone, while from 2015 the assessment has also included an endocrinologist, a transplant surgeon and a psychiatrist in a multidisciplinary team. Method The proportion of patients accepted for transplantation before and after the multidisciplinary approach were compared. A chi square test was used for comparing the groups in the two periods; 2010-2014 versus 2015-2019 vs. P-values are reported according to two- tailed analysis, and p- values < 0.05 were considered statistically significant. Results From 2010 to December 2019, 144 patients were assessed for β-cell replacement therapy eligibility. Out of all patients referred, 64 out of 79 (81%) and 22 out of 65 (34%) were listed for transplantation before and after the multidisciplinary assessment was introduced (p-value < 0.005). The main reasons for not being listed after the introduction of a multidisciplinary team were suboptimal diabetes treatment and that the patients withdrew their interest after the outpatient clinic visit with thorough information about advantages and risks. Conclusion The rate of patients who were accepted for islet or single pancreas transplantation declined after a multidisciplinary approach was introduced for transplant candidate eligibility. We suggest that a broader, multi-disciplinary approach revealed previously undetected medical issues and improved patient information that subsequently resulted in fewer patients listed for transplantation.

scholarly journals Defining outcomes for β-cell replacement therapy in the treatment of diabetes: a consensus report on the Igls criteria from the IPITA/EPITA opinion leaders workshop

2018 ◽  
Vol 31 (4) ◽  
pp. 343-352 ◽  
Author(s):  
Michael R. Rickels ◽  
Peter G. Stock ◽  
Eelco J. P. de Koning ◽  
Lorenzo Piemonti ◽  
Johann Pratschke ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Opinion Leaders ◽  
Cell Replacement Therapy ◽  
Β Cell ◽  
Cell Replacement ◽  
Treatment Of Diabetes ◽  
Consensus Report

scholarly journals Defining Outcomes for β-cell Replacement Therapy in the Treatment of Diabetes

2018 ◽  
Vol 102 (9) ◽  
pp. 1479-1486 ◽  
Author(s):  
Michael R. Rickels ◽  
Peter G. Stock ◽  
Eelco J.P. de Koning ◽  
Lorenzo Piemonti ◽  
Johann Pratschke ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Cell Replacement Therapy ◽  
Β Cell ◽  
Cell Replacement ◽  
Treatment Of Diabetes

Examination of the Igls Criteria for Defining Functional Outcomes of β-Cell Replacement Therapy: IPITA symposium report

2021 ◽  
Author(s):  
Cyril P Landstra ◽  
Axel Andres ◽  
Mikael Chetboun ◽  
Caterina Conte ◽  
Yvonne Kelly ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Evidence Synthesis ◽  
Artificial Pancreas ◽  
Graft Function ◽  
Transplant Recipients ◽  
Cell Replacement Therapy ◽  
Β Cell ◽  
C Peptide ◽  
Cell Replacement ◽  
Islet Transplant

Abstract Context The Igls criteria were developed to provide a consensus definition for outcomes of β-cell replacement therapy in the treatment of diabetes during a January 2017 workshop sponsored by the International Pancreas & Islet Transplant Association (IPITA) and the European Pancreas & Islet Transplant Association (EPITA). In July 2019, a symposium at the 17 th IPITA World Congress was held to examine the Igls criteria after two years in clinical practice, including validation against continuous glucose monitoring (CGM)-derived glucose targets, and to propose future refinements that would allow for comparison of outcomes with artificial pancreas system approaches. Evidence acquisition Utilization of the criteria in various clinical and research settings were illustrated by population as well as individual outcome data of four islet and/or pancreas transplant centers. Validation against CGM metrics was conducted in 55 islet transplant recipients followed-up to 10 years from a fifth center. Evidence synthesis The Igls criteria provided meaningful clinical assessment on an individual patient and treatment group level, allowing for comparison both within and between different β-cell replacement modalities. Important limitations include the need to account for changes in insulin requirements and C-peptide levels relative to baseline. In islet transplant recipients, CGM glucose time-in-range improved with each category of increasing β-cell graft function. Conclusions Future Igls 2.0 criteria should consider absolute rather than relative levels of insulin use and C-peptide as qualifiers with treatment success based on glucose assessment using CGM-metrics on par with assessment of HbA1c and severe hypoglycemia events.

scholarly journals β-cell regeneration and differentiation: how close are we to the ‘holy grail’?

2014 ◽  
Vol 53 (3) ◽  
pp. R119-R129 ◽  
Author(s):  
Gemma Tan ◽  
Andrew G Elefanty ◽  
Edouard G Stanley
Keyword(s):  
Stem Cell ◽  
Replacement Therapy ◽  
Cell Biology ◽  
Glucose Monitoring ◽  
Cellular Reprogramming ◽  
Exogenous Insulin ◽  
Β Cells ◽  
Cell Replacement Therapy ◽  
Β Cell ◽  
Cell Replacement

Diabetes can be managed by careful monitoring of blood glucose and timely delivery of exogenous insulin. However, even with fastidious compliance, people with diabetes can suffer from numerous complications including atherosclerosis, retinopathy, neuropathy, and kidney disease. This is because delivery of exogenous insulin coupled with glucose monitoring cannot provide the fine level of glucose control normally provided by endogenous β-cells in the context of intact islets. Moreover, a subset of people with diabetes lack awareness of hypoglycemic events; a status that can have grave consequences. Therefore, much effort has been focused on replacing lost or dysfunctional β-cells with cells derived from other sources. The advent of stem cell biology and cellular reprogramming strategies have provided impetus to this work and raised hopes that a β-cell replacement therapy is on the horizon. In this review, we look at two components that will be required for successful β-cell replacement therapy: a reliable and safe source of β-cells and a mechanism by which such cells can be delivered and protected from host immune destruction. Particular attention is paid to insulin-producing cells derived from pluripotent stem cells because this platform addresses the issue of scale, one of the more significant hurdles associated with potential cell-based therapies. We also review methods for encapsulating transplanted cells, a technique that allows grafts to evade immune attack and survive for a long term in the absence of ongoing immunosuppression. In surveying the literature, we conclude that there are still several substantial hurdles that need to be cleared before a stem cell-based β-cell replacement therapy for diabetes becomes a reality.

Bioengineering, biomaterials, and β-cell replacement therapy

2020 ◽  
pp. 461-486
Author(s):  
Rick de Vries ◽  
Adam Stell ◽  
Sami Mohammed ◽  
Carolin Hermanns ◽  
Adela Helvia Martinez ◽  
...  
Keyword(s):  
Replacement Therapy ◽  
Cell Replacement Therapy ◽  
Β Cell ◽  
Cell Replacement
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