دورية أكاديمية
Diagnosis and treatment of allograft rejection in islet transplantation.
| العنوان: | Diagnosis and treatment of allograft rejection in islet transplantation. |
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| المؤلفون: | Landstra CP; Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands., Nijhoff MF; Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands; Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands., Roelen DL; Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands; Department of Immunohematology, Leiden University Medical Center, Leiden, The Netherlands., de Vries APJ; Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands; Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands., de Koning EJP; Department of Internal Medicine, Leiden University Medical Center, Leiden, The Netherlands; Leiden Transplant Center, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: e.j.p.de_koning@lumc.nl. |
| المصدر: | American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2023 Sep; Vol. 23 (9), pp. 1425-1433. Date of Electronic Publication: 2023 Jun 10. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Country of Publication: United States NLM ID: 100968638 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1600-6143 (Electronic) Linking ISSN: 16006135 NLM ISO Abbreviation: Am J Transplant Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2023- : [New York] : Elsevier Original Publication: Copenhagen : Munksgaard International Publishers, 2001- |
| مواضيع طبية MeSH: | Islets of Langerhans Transplantation*/methods , Hyperglycemia*/diagnosis , Hyperglycemia*/drug therapy , Hyperglycemia*/etiology, Humans ; C-Peptide ; Peptides ; Allografts |
| مستخلص: | Islet transplantation stabilizes glycemic control in patients with complicated diabetes mellitus. Rapid functional decline could be due to islet allograft rejection. However, there is no reliable method to assess rejection, and treatment protocols are absent. We aimed to characterize diagnostic features of islet allograft rejection and assess effectiveness of high-dose methylprednisolone treatment. Over a median follow-up of 61.8 months, 22% (9 of 41) of islet transplant recipients experienced 10 suspected rejection episodes (SREs). All first SREs occurred within 18 months after transplantation. Important features were unexplained hyperglycemia (all cases), unexplained C-peptide decrease (ΔC-peptide, 77.1% [-59.1% to -91.6%]; ΔC-peptide:glucose, -76.3% [-49.2% to -90.4%]), predisposing event (5 of 10 cases), and increased immunologic risk (5 of 10 cases). At 6 months post-SRE, patients who received protocolized methylprednisolone (n = 4) had significantly better islet function than untreated patients (n = 4), according to C-peptide (1.39 ± 0.59 vs 0.14 ± 0.19 nmol/L; P = .007), Igls score (good [4 of 4 cases] vs failure [3 of 4 cases] or marginal [1 of 4 cases]; P = .018) and β score (6.0 [6.0-6.0] vs 1.0 [0.0-3.5]; P = .013). SREs are prevalent among islet transplant recipients and are associated with loss of islet graft function. Timely treatment with high-dose methylprednisolone mitigates this loss. Unexplained hyperglycemia, unexpected C-peptide decrease, a predisposing event, and elevated immunologic risk are diagnostic indicators for SRE. (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: diagnosis; diagnostic criteria; immunosuppression; islet allograft rejection; islet graft function; islet graft function loss; islet transplantation; methylprednisolone; rejection; treatment; type 1 diabetes |
| المشرفين على المادة: | 0 (C-Peptide) 0 (Peptides) |
| تواريخ الأحداث: | Date Created: 20230612 Date Completed: 20230904 Latest Revision: 20230915 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1016/j.ajt.2023.05.035 |
| PMID: | 37307954 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1600-6143 |
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| DOI: | 10.1016/j.ajt.2023.05.035 |