Transplant Surgeons and Diabetes Researcher Present Breakthroughs at International Meeting

Research on pancreas transplantation from three Miller School faculty members who have been at the forefront of innovative immunosuppression protocols for kidneys and kidney-pancreas transplantation was featured prominently at the International Pancreas and Islet Cell Transplant Association meeting, held in Prague in June.

The work, a joint effort of the Lillian Jean Kaplan Renal Transplant Program, the Division of Kidney and Pancreas Transplantation and the Diabetes Research Institute (DRI), was presented at a plenary lecture by George Burke III, M.D., the Joshua Miller Chair of Transplant Surgery in the Lillian Jean Kaplan Renal Transplant Program, professor of surgery and director of the Division of Kidney and Pancreas Transplantation; Gaetano Ciancio, M.D., professor of surgery and urology, and associate director of the Division of Kidney and Pancreas Transplantation; and Alberto Pugliese, M.D., research professor of medicine in the Division of Endocrinology, Diabetes and Metabolism, Microbiology and Immunology, and director of the Immunogenetics Program at the DRI. In addition, two of their abstracts were selected as two of the six “Best Abstracts” from more than three hundred presented at the prestigious meeting.

Dr. Ciancio presented the long-term results of a 10-year, randomized prospective study comparing two immunosuppression drugs used to prevent rejection, rapamycin vs. mycophenalate mofetil (MMF), in kidney-pancreas transplant patients. This type of transplant is indicated for patients with type 1 diabetes who have developed end-stage renal disease. Long-term acceptance of the transplanted organs is critical for restoring normal blood sugar and renal function. The surgeons demonstrated that rapamycin was as effective as the traditionally used MMF with equal patient and graft survival. However, rapamycin therapy was associated with significantly less rejection.

Drs. Pugliese, Burke and Ciancio have been collaborating on a long-term study examining the recurrence of type 1 diabetes in patients with kidney-pancreas transplants. They found that transplant patients can return to high blood sugars even after many years of normal pancreas transplant function. Importantly, they found that diabetes may recur despite immunosuppression that prevents rejection.

Dr. Pugliese was an invited speaker for a plenary talk on diabetes recurrence, delivered by Dr. Burke, in which he presented data demonstrating the reactivation of the autoimmune process that caused type 1 diabetes in the first place. In a related abstract presentation, Dr. Burke showed data that autoantibodies, in particular those against a recently discovered molecule, ZnT8, are associated with diabetes recurrence and can be used as risk markers.

The team is now evaluating transplant recipients to look for those with autoantibodies. “We believe that the presence of autoantibodies is a strong marker for a future recurrence of diabetes,” Dr. Pugliese said. “The goal now is to involve other transplant centers in the country and investigate more effective interventional therapies.”

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