Lessons From Pancreas Transplantation in Type 1 Diabetes: Recurrence of Islet Autoimmunity
| العنوان: | Lessons From Pancreas Transplantation in Type 1 Diabetes: Recurrence of Islet Autoimmunity |
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| المؤلفون: | Sahil K. Virdi, Helena Reijonen, Shari Messinger, Linda Chen, Alberto Pugliese, George W. Burke, Phillip Ruiz, Gaetano Ciancio, Francesco Vendrame |
| المصدر: | Current Diabetes Reports. 15 |
| بيانات النشر: | Springer Science and Business Media LLC, 2015. |
| سنة النشر: | 2015 |
| مصطلحات موضوعية: | Autoimmune disease, Type 1 diabetes, business.industry, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, Autoimmunity, Immunosuppression, Pancreas transplantation, medicine.disease, medicine.disease_cause, Diabetes Mellitus, Type 1, medicine.anatomical_structure, Recurrence, Diabetes mellitus, Immunology, Internal Medicine, Humans, Medicine, Pancreas Transplantation, business, Pancreas, Insulitis, Autoantibodies |
| الوصف: | Type 1 diabetes recurrence (T1DR) affecting pancreas transplants was first reported in recipients of living-related pancreas grafts from twins or HLA identical siblings; given HLA identity, recipients received no or minimal immunosuppression. This observation provided critical evidence that type 1 diabetes (T1D) is an autoimmune disease. However, T1DR is traditionally considered very rare in immunosuppressed recipients of pancreas grafts from organ donors, representing the majority of recipients, and immunological graft failures are ascribed to chronic rejection. We have been performing simultaneous pancreas-kidney (SPK) transplants for over 25 years and find that 6-8 % of our recipients develop T1DR, with symptoms usually becoming manifest on extended follow-up. T1DR is typically characterized by (1) variable degree of insulitis and loss of insulin staining, on pancreas transplant biopsy (with most often absent), minimal to moderate and rarely severe pancreas, and/or kidney transplant rejection; (2) the conversion of T1D-associated autoantibodies (to the autoantigens GAD65, IA-2, and ZnT8), preceding hyperglycemia by a variable length of time; and (3) the presence of autoreactive T cells in the peripheral blood, pancreas transplant, and/or peripancreatic transplant lymph nodes. There is no therapeutic regimen that so far has controlled the progression of islet autoimmunity, even when additional immunosuppression was added to the ongoing chronic regimens; we hope that further studies and, in particular, in-depth analysis of pancreas transplant biopsies with recurrent diabetes will help identify more effective therapeutic approaches. |
| تدمد: | 1539-0829 1534-4827 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::56913dbcb02f48f8e5d9b32476349104Test https://doi.org/10.1007/s11892-015-0691-5Test |
| حقوق: | CLOSED |
| رقم الانضمام: | edsair.doi.dedup.....56913dbcb02f48f8e5d9b32476349104 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15390829 15344827 |
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