medwireNews: Islet transplantation (IT) significantly reduces the risk for long-term complications in people with type 1 diabetes, study findings indicate.
The risk reductions were driven by a lower risk for death in people who received IT but had not undergone kidney transplantation, and by a reduced need for dialysis in those who had received kidney transplantation, report Quentin Perrier (Grenoble Alpes University Hospital, France) and co-authors in Diabetes Care.
They say their findings “provide comprehensive insights into the long-term benefits (>10 years) and potential risks associated with ITA [islet transplantation alone] and IAK [islet-after-kidney transplantation].”
And they add: “It is important to highlight that these positive results for IT were achieved without long-term insulin independence.”
The researchers identified 61 ITA recipients with unstable type 1 diabetes who had participated in three IT clinical trials and were followed up for a mean of 10.4 years. These patients were matched by age, sex, history of dialysis, lower limb amputation, stroke, myocardial infarction (MI) and transient ischemic attack (TIA) to 601 people with type 1 diabetes who had not undergone IT.
Analysis showed that the ITA recipients were 61% less likely than controls to reach the composite outcome of death, dialysis, lower limb amputation, nonfatal stroke, nonfatal MI, and TIA. Analysis of the individual components showed that the risk for death was a significant 78% lower among ITA recipients versus controls but there was no significant difference between the two groups in the risks for dialysis, amputation, stroke, MI, or TIA.
The study also included 45 IAK recipients, with a median 13.4 years of follow-up, and 45 matched controls who had undergone kidney transplantation but had not received IT.
Perrier et al report that individuals in the IAK group had a significant 48% lower risk for the composite outcome than their matched controls. In this case, the risk reduction was driven by a significant 81% lower risk for dialysis with versus without IAK.
There were no significant differences between the two groups in the risks for death, amputation, stroke, or TIA. And there was a significant 4.2-fold higher risk for MI among IAK recipients versus controls, which “contradicts several studies that have demonstrated improvements in cardiovascular function,” say the researchers. They point out that the small sample size meant that the IAK group and controls were mismatched for age and history of MI, which may explain the discrepancy.
There was no significant difference in cancer risk with versus without IT regardless of whether the procedure was carried out alone or after kidney transplantation, and the researchers describe this finding as “noteworthy” because the immunosuppressive treatment needed for IT “is known to carry oncogenic risks.”
They say that “the current study provides reassurance regarding the safety profile of ITA in this regard” and hypothesize that the improved glycemic control that occurs after ITA “may counterbalance the oncogenic risk associated with immunosuppressive treatment.”
Although Perrier et al point out that the data should be interpreted with caution due to the small number of events, they conclude that “the insights gleaned from this study contribute to the growing body of evidence supporting the positive impact of IT on long-term patient outcomes.”
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