Simultaneous islet and kidney transplantation in seven patients with type 1 diabetes and end-stage renal disease using a glucocorticoid-free immunosuppressive regimen with alemtuzumab induction

Abstract

OBJECTIVE-The aim of this study was to evaluate the efficiency and safety of simultaneous islet and kidney transplantation in patients with type 1 diabetes and end-stage renal disease using a glucocorticoid-free immunosuppressive regimen with alemtuzumab induction. RESEARCH DESIGN AND METHODS-Seven patients with type 1 diabetes and end-stage renal failure were transplanted with allogenic islets and kidneys procured from brain-dead donors. To prevent organ rejection, patients received alemtu- zumab for induction immunosuppression, followed by sirolimus and tacrolimus. No glucocorticoids were given at any time. RESULTS-The median duration of follow-up was 18.3 months (range 13-31). Kidney survival was 100%. Four patients became insulin independent at 1 year. The other three reduced insulin use to less than 25% of the amount required before transplantation. Serum C-peptide levels were significantly greater posttrans- plant in all patients, indicating continued islet function. No major procedure-related complications were observed. CONCLUSIONS-Our results demonstrate that a steroid-free immunosuppressive regimen consisting of alemtuzumab, siroli- mus, and tacrolimus is feasible for simultaneous islet and kidney transplantation. The question of whether this induction regimen is superior to more standard induction deserves large studies. © 2008 by the American Diabetes Association.