Abstract
Total pancreatectomy with islet autotransplantation (TPIAT) is performed for definitive treatment of chronic pancreatitis; patients are not diabetic before surgery, or have C-peptide positive pancreatogenous diabetes. Thus, TPIAT recipients are not traditionally considered at risk for autoimmune loss of the islet graft. We describe a 43-year-old female who underwent TPIAT with high mass islet graft of 6031-IEQ/kg, with no evidence of presurgical β cell autoimmunity who developed type 1 diabetes within the first year after TPIAT, resulting in complete loss of beta cell function. The patient had positive GAD and insulin autoantibodies at 1 year and 18 months after TPIAT, not present prior, and undetectable C-peptide after mixed meal and intravenous glucose tolerance testing at 18 months. Glucagon secretion was preserved, suggesting the transplanted alpha cell mass was intact. HLA typing revealed a DR3/DR4 class II haplotype. This case highlights the need to consider de novo type 1 diabetes in patients with unexpected islet graft failure after TPIAT. The authors report a novel case of rapid beta cell failure due to de novo type 1 diabetes presenting after total pancreatectomy and islet autotransplantation, highlighting the need to consider autoimmunity as a cause of unexpected graft failure in islet autotransplant recipients.
Original language | English (US) |
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Pages (from-to) | 1991-1994 |
Number of pages | 4 |
Journal | American Journal of Transplantation |
Volume | 15 |
Issue number | 7 |
DOIs | |
State | Published - Jul 1 2015 |
Bibliographical note
Publisher Copyright:© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
Keywords
- autoimmunity
- autotransplantation
- diabetes: type 1
- insulin / C-peptide
- islets of Langerhans