NORMOGLYCEMIA AFTER TRANSPLANTATION OF FRESHLY ISOLATED AND CRYOPRESERVED PANCREATIC-ISLETS IN TYPE-1 (INSULIN-DEPENDENT) DIABETES-MELLITUS

Purified islets of Langerhans and a kidney were transplanted into a 36-year-old patient who suffered from renal failure secondary to a 25 year history of Type 1 (insulin-dependent) diabetes mellitus. The islet graft contained 243 000 fresh islets (mean islet diameter 150 mu-m) that were syngeneic with the kidney graft and 368 000 cryopreserved islets that had been collected from four other donors. The total of 10 000 islets/kg body weight was infused into the liver via the umbilical vein. Immunosuppression was induced with antilymphocyte globulin and maintained with prednisone, cyclosporine and azathioprine. Serum C-peptide levels (ng/ml) during fasting and after standard mixed meal feeding (Sustacal) were < 0.12 preoperatively. Postoperatively, insulin secretion was restored: fasting C-peptide rose during the first 4 weeks to levels of 4 to 5 and Sustacal elicited a further rise to 6 to 7. Transplant renal function was stable. Daily fasting glucose (mmol/l, mean +/- SD) was 5.6 +/- 1 and 5.3 +/- 0.6 during the first and second months respectively and post-Sustacal glucose was 5.7 +/- 0.8. Exogenous insulin therapy was progressively withdrawn and stopped during the ninth week. Thereafter, fasting glucose was 4.7 +/- 0.5, 24h mean glucose was 6.6 +/- 0.5, and normoglycaemia was maintained after Sustacal. These data show that this mass of freshly isolated and cryopreserved islets from multiple donors provided sustained function (3 months) that reversed insulin-dependence in an immunosuppressed Type 1 diabetic patient treated with simultaneous islet-kidney transplantation.