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HLA-A∗24 carrier status and autoantibody surges posttransplantation associate with poor functional outcome in recipients of an islet allograft

par Demeester, Simke;Pipeleers, Daniel;Gorus, Frans;Keymeulen, Bart;Balke, Else E.M.;Van Der Auwera, Bart J R B.J.;Gillard, Pieter;Hilbrands, Robert;Lee, Da Hae ;Van De Velde, Ursule;Ling, Zhidong;Roep, Bart
Référence Diabetes care, 39, 6, page (1060-1064)
Publication Publié, 2016-06

Article révisé par les pairs

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Résumé :

OBJECTIVE We investigated whether changes in islet autoantibody profile and presence of HLA risk markers, reported to predict rapid β- cell loss in pre-type 1 diabetes, associate with poor functional outcome in islet allograft recipients. RESEARCH DESIGN AND METHODS Forty- one patients received ≥2.3 million β-cells/kg body wt in one to two intraportal implantations. Outcome after 6-18 months was assessed by C-peptide (random and stimulated), insulin dose, and HbA1c . RESULTS Patients carrying HLA-A∗24-positive or experiencing a significant autoantibody surge within 6 months after the first transplantation (n 5 19) had lower C-peptide levels (P ≤ 0.003) and higher insulin needs (P < 0.001) despite higher HbA1c levels (P ≤ 0.018). They became less often insulin independent (16% vs. 68%, P 5 0.002) and remained less often C- peptide positive (47% vs. 100%, P < 0.001) than recipients lacking both risk factors. HLA-A∗24 positivity or an autoantibody surge predicted insulin dependence (P 5 0.007). CONCLUSIONS HLA-A∗24 and early autoantibody surge after islet implantation associate with poor functional graft outcome.