Human islet allotransplantation with Basiliximab in type I diabetic patients with end-stage renal failure

Abstract

ISLET allotransplantation is still an experimental procedure for treatment of type I diabetic patients with end-stage renal failure. There are a variety of immunologic and nonimmunologic factors determining the fate of an islet allograft. An analysis of the results reported to the International Islet Transplant Registry shows a benefit for anti–T-cell induction therapy in human islet allotransplantation. However, in the cyclosporine era, the routine use of antilymphocyte sera in renal allotransplantation has been abandoned by most centers. In light of the rather modest results presently obtained in type I diabetic patients with end-stage renal disease, it is questionable whether the increased risk for infectious and malignant disease secondary to administration of depleting antilymphocyte sera can be justified for a pancreatic islet allograft. Furthermore, new monoclonal anti–interleukin-2 receptor antibodies have shown efficacy in the prevention of acute kidney allograft rejection and seem to have fewer side effects than antilymphocyte sera. Moreover, results reported recently by the Edmonton group on islet transplantation alone in nonuremic type I diabetic patients suggest that depleting anti–T-cell induction therapy is not necessary. In this study, we tested whether the results of treatment with the monoclonal anti–interleukin-2 receptor antibody Basiliximab (Simulect, Novartis) are comparable to those obtained using a depleting antilymphocyte antibody for induction therapy in end-stage kidney disease patients receiving human islet allotransplantation for type I diabetes. PATIENTS AND METHODS