Long-term survival in kidney transplant recipients with type 1 following islet transplantation
Study findings report significant reduction in risk of transplantation failure and enhances life expectancy in individuals with type 1 diabetes who have kidney transplantation, a new study has revealed.
The study found that islet transplantation exhibited a substantial advantage over insulin treatment, significantly reducing the risk of transplant failure and mortality.
The findings were presented at the European Society for Organ Transplantation (ESOT) Congress 2023.
Researchers compared the long-term outcomes of patients with type 1 diabetes who underwent kidney transplantation and received an islet transplantation, with patients who underwent kidney transplantation and then managed their diabetes with insulin alone.
The researchers investigated every patient with type 1 diabetes in France who received a kidney transplant between 2000 and 2017. Among 2,393 patients, 327 were eligible for islet transplantation, including 47 that were transplanted with islets.
To ensure comparability between the two groups, the researchers matched patients based on factors, such as the year of transplantation, age of the recipient, kidney function, or HBA1c.
After comparing the two groups, the researchers found that islet transplantation had a significant benefit over insulin alone in terms of reducing the risk of transplantation failure and death.
The results showed a 53% lower risk of failure compared with the insulin-only group.
In addition, patients who received an islet transplantation had a higher estimated life expectancy for a 10-year follow-up (9.61 years compared with 8.85 years for those on insulin alone).
The researchers noted two significant positive results in their study.
At the one-year mark following the islet transplantation, there was an estimated 89.4% probability of graft survival.
Secondly, patients were estimated to have a 70.2% probability of achieving independence from insulin at one year.
Dr Mehdi Maanaoui, a nephrologist at the University of Lille, specialising in kidney and islet transplantation and lead author of the study, said: "Although islet transplantation has previously been shown to improve glycaemic control compared with conventional insulin therapy in recent clinical trials, little was known about its long-term impact on patient prognosis until now.
“These results are exciting and provide hope for people living with type 1 diabetes and kidney transplants.
"Islet transplantation could be a game-changer in the management of type 1 diabetes, and our research demonstrates a clear association between islet transplantation and a substantial increase in life expectancy.”
In 2021, there were estimated to be approximately 8.4 million individuals around the world with type 1 diabetes.
New diagnoses are expected to rise, with projections ranging from 13.5 to 17.4 million cases predicted by 2040.
It is estimated that around 30% of patients with type 1 diabetes will suffer from kidney failure.
These figures highlight the escalating public health challenge posed by type 1 diabetes and the urgent need for effective management and treatment strategies to address this increasing burden on healthcare systems worldwide.
Dr Maanaoui concluded: "Whilst further research is required to ensure the outcomes of islet transplantation begin to match the long-term success achieved with pancreas transplantation, we hope these findings help to increase patient access to islet transplantation.”
Professor Paul Johnson, Director of the DRWF Human Islet Isolation Facility at the Churchill Hospital, Oxford Centre for Diabetes, Endocrinology and Metabolism (OCDEM), said: “Although several studies have previously shown the advantage of islet transplantation over conventional insulin treatment, this is one of the first studies to definitively demonstrate the impact of this advantage on the survival of kidney transplants in patients with type 1 diabetes.”
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