Experience with a novel efalizumab-based immunosuppressive regimen to facilitate single donor islet cell transplantation

摘要: Islet transplantation is an experimental therapy for selected patients with type 1 diabetes (T1DM). It remains limited by immunosuppressive drug toxicity, progressive loss of insulin independence, allosensitization and the need multiple islet donors. We describe our experience efalizumab-based regimen as compared to prevailing standard regimen, Edmonton protocol. Twelve T1DM received transplants: eight were treated protocol; four daclizumab induction, a 6-month course tacrolimus, maintenance efalizumab mycophenolate mofetil. The primary endpoint was independence after one infusion. Only two protocol achieved endpoint; six required islets from donors, all experienced leukopenia, mouth ulcers, anemia, diarrhea hypertransaminasemia. Four became allosensitized. All normal hemoglobin A1c single cell infusion remained independent while on efalizumab. These significantly fewer side effects none Trial continuation terminated withdrawal market. data suggest that this prevents rejection, well tolerated, allows donor transplantation.