• James F Markmann, Shaoping Deng, Xiaolun Huang, Niraj M Desai, Ergun H Velidedeoglu, Chengyang Lui, Adam Frank, Eileen Markmann, Maral Palanjian, Kenneth Brayman, Bryan Wolf, Ewan Bell, Marko Vitamaniuk, Nicolai Doliba, Franz Matschinsky, Clyde F Barker, and Ali Naji.
• Department of Surgery, University of Pennsylvania Health System, Hospital of the University of Pennsylvania, 4th Floor Silverstein, 3400 Spruce Street, Philadelphia, PA 19104, USA. james.markmann@uphs.upenn.edu
• Ann. Surg. 2003 Jun 1; 237 (6): 741750741-9; discussion 749-50.

ObjectiveTo restore islet function in patients whose labile diabetes subjected them to frequent dangerous episodes of hypoglycemic unawareness, and to determine whether multiple transplants are always required to achieve insulin independence.Summary Background DataThe recent report by the Edmonton group documenting restoration of insulin independence by islet transplantation in seven consecutive patients with type 1 diabetes differed from previous worldwide experience of only sporadic success. In the Edmonton patients, the transplanted islet mass critical for success was approximately more than 9,000 IEq/kg of recipient body weight and required two or three separate transplants of islets isolated from two to four cadaveric donors. Whether the success of the Edmonton group can be recapitulated by others, and whether repeated transplants using multiple donors will be a universal requirement for success have not been reported.MethodsThe authors report their treatment with islet transplantation of nine patients whose labile type 1 diabetes was characterized by frequent episodes of dangerous hypoglycemia.ResultsIn each of the seven patients who have completed the treatment protocol (i.e., one or if necessary a second islet transplant), insulin independence has been achieved. In five of the seven patients only a single infusion of islets was required. To date, only one recipient has subsequently lost graft function, after an initially successful transplant. This patient suffered recurrent hyperglycemia 9 months after the transplant.ConclusionsThis report confirms the efficacy of the Edmonton immunosuppressive regimen and indicates that insulin independence can often be achieved by a single transplant of sufficient islet mass.

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