EVIDENCE OF RECURRENT AUTOIMMUNITY IN HUMAN ALLOGENEIC ISLET TRANSPLANTATION

TLDR

The study proposes using the forearm subfascial compartment as a site to monitor islet rejection and autoimmune recurrence in therapeutic intraportal islet allografts. Ten thousand handpicked human pancreatic islets were transplanted into the forearm subfascial compartment of a type I diabetic recipient on cyclosporine, azathioprine, and prednisone. Biopsies showed normal islets at day 7 but a dense mononuclear infiltrate and preferential loss of insulin‑producing cells by day 14, indicating recurrent autoimmune diabetes in the allograft.

Abstract

We transplanted 10,000 isolated, handpicked human pancreatic islets into the subfascial compartment of the forearm muscle of a type I diabetic recipient who had received a successful renal transplant one year prior. The recipient was maintained on his usual immunosuppressive therapy of cyclosporine, azathioprine, and prednisone. A biopsy performed 7 days after transplantation showed normal islets with both insulin- and glucagon-staining cells present and no lymphocytic infiltration. A second biopsy performed 14 days after transplantation showed a dense mononuclear cell infiltrate with a preferential loss of insulin-staining cells relative to glucagon-staining cells in the islets. These data are consistent with recurrent autoimmune diabetes in an isolated islet allograft in an immunosuppressed type I diabetic recipient. In addition, this forearm subfascial site may be a useful means to monitor islet rejection and autoimmune recurrence in therapeutic intraportal islet allografts.