Alloantibody and autoantibody monitoring predicts islet transplantation outcome in human type 1 diabetes

Lorenzo Piemonti, Matthew J. Everly, Paola Maffi, Marina Scavini, Francesca Poli, Rita Nano, Massimo Cardillo, Raffaella Melzi, Alessia Mercalli, Valeria Sordi, Vito Lampasona, Alejandro Espadas De Arias, Mario Scalamogna, Emanuele Bosi, Ezio Bonifacio, Antonio Secchi, Paul I. Terasaki

Research output: Contribution to journalArticle

60 Citations (Scopus)

Abstract

Long-term clinical outcome of islet transplantation is hampered by the rejection and recurrence of autoimmunity. Accurate monitoring may allow for early detection and treatment of these potentially compromising immune events. Islet transplant outcome was analyzed in 59 consecutive pancreatic islet recipients in whom baseline and de novo posttransplant autoantibodies (GAD antibody, insulinoma-associated protein 2 antigen, zinc transporter type 8 antigen) and donor-specific alloantibodies (DSA) were quantified. Thirty-nine recipients (66%) showed DSA or autoantibody increases (de novo expression or titer increase) after islet transplantation. Recipients who had a posttransplant antibody increase showed similar initial performance but significantly lower graft survival than patients without an increase (islet autoantibodies P <0.001, DSA P <0.001). Posttransplant DSA or autoantibody increases were associated with HLA-DR mismatches (P = 0.008), induction with antithymocyte globulin (P = 0.0001), and pretransplant panel reactive alloantibody >15% in either class I or class II (P = 0.024) as independent risk factors and with rapamycin as protective (P = 0.006) against antibody increases. DSA or autoantibody increases after islet transplantation are important prognostic markers, and their identification could potentially lead to improved islet cell transplant outcomes.

Original languageEnglish
Pages (from-to)1656-1664
Number of pages9
JournalDiabetes
Volume62
Issue number5
DOIs
Publication statusPublished - May 2013

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Isoantibodies
Islets of Langerhans Transplantation
Type 1 Diabetes Mellitus
Autoantibodies
Tissue Donors
Islets of Langerhans
Antibodies
Class 8 Receptor-Like Protein Tyrosine Phosphatases
Transplants
Antigens
Graft Survival
Sirolimus
Autoimmunity
Recurrence
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism

Cite this

Alloantibody and autoantibody monitoring predicts islet transplantation outcome in human type 1 diabetes. / Piemonti, Lorenzo; Everly, Matthew J.; Maffi, Paola; Scavini, Marina; Poli, Francesca; Nano, Rita; Cardillo, Massimo; Melzi, Raffaella; Mercalli, Alessia; Sordi, Valeria; Lampasona, Vito; De Arias, Alejandro Espadas; Scalamogna, Mario; Bosi, Emanuele; Bonifacio, Ezio; Secchi, Antonio; Terasaki, Paul I.

In: Diabetes, Vol. 62, No. 5, 05.2013, p. 1656-1664.

Research output: Contribution to journalArticle

Piemonti, Lorenzo ; Everly, Matthew J. ; Maffi, Paola ; Scavini, Marina ; Poli, Francesca ; Nano, Rita ; Cardillo, Massimo ; Melzi, Raffaella ; Mercalli, Alessia ; Sordi, Valeria ; Lampasona, Vito ; De Arias, Alejandro Espadas ; Scalamogna, Mario ; Bosi, Emanuele ; Bonifacio, Ezio ; Secchi, Antonio ; Terasaki, Paul I. / Alloantibody and autoantibody monitoring predicts islet transplantation outcome in human type 1 diabetes. In: Diabetes. 2013 ; Vol. 62, No. 5. pp. 1656-1664.
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