Glycemia, hypoglycemia, and costs of simultaneous islet-kidney or islet after kidney transplantation versus intensive insulin therapy and waiting list for islet transplantation

Philipp A Gerber, Rebecca Locher, Richard A Zuellig, Oliver Tschopp, Evelyne Ajdler-Schaeffler, Philipp Kron, Christian Oberkofler, Michael Brändle, Giatgen A Spinas, Roger Lehmann
2015
BACKGROUND: Long-term data of patients with type 1 diabetes mellitus (T1D) after simultaneous islet-kidney (SIK) or islet-after-kidney transplantation (IAK) are rare and have never been compared to intensified insulin therapy (IIT). METHODS: Twenty-two patients with T1D and endstage renal failure undergoing islet transplantation were compared to 70 patients matched for age and diabetes duration treated with IIT and to 13 patients with kidney transplantation alone or simultaneous pancreas-kidney
more » ... ous pancreas-kidney after loss of pancreas function (waiting list for IAK [WLI]). Glycemic control, severe hypoglycemia, insulin requirement, and direct medical costs were analyzed. RESULTS: Glycated hemoglobin decreased significantly from 8.2 ± 1.5 to 6.7 ± 0.9% at the end of follow-up (mean 7.2 ± 2.5 years) in the SIK/IAK and remained constant in IIT (7.8 ± 1.0% and 7.6 ± 1.0) and WLI (7.8 ± 0.8 and 7.9 ± 1.0%). Daily insulin requirement decreased from 0.53 ± 0.15 to 0.29 ± 0.26 U/kg and remained constant in IIT (0.59 ± 0.19 and 0.58 ± 0.23 U/kg) and in WLI (0.76 ± 0.28 and 0.73 ± 0.11 U/kg). Severe hypoglycemia dropped in SIK/IAK from 4.5 ± 9.7 to 0.3 ± 0.7/patient-year and remained constant in IIT (0.1 ± 0.7 and 0.2 ± 0.8/patient-year). Detailed cost analysis revealed US 57, 525of additionalcostf orislettransplantation5yearsaf tertransplantation.Basedona5 − and10 − yearanalysis, costneutralityisassumedtobeachieved15yearsaf tertransplantation.CON CLU SION S : T hislong− termcohortwithmorethan7yearsof f ollow−upshowsthatglycemiccontrolinpatientswithT 1Daf terSIK/IAKtransplanta
doi:10.5167/uzh-111538 fatcat:mdz2p2scurhitee4pidexox5bq