EVIDENCE OF RECURRENT AUTOIMMUNITY IN HUMAN ALLOGENEIC ISLET TRANSPLANTATION

We transplanted 10,000 isolated, handpicked human pancreatic islets in to the subfascial compartment of the forearm muscle of a type I diabet ic recipient who had received a successful renal. transplant one year prior. The recipient was maintained on his usual immunosuppressive the rapy of cyclosporine, azathioprine, and prednisone. A biopsy performed 7 days after transplantation showed normal islets with both insulin- and glucagon-staining cells present and no lymphocytic infiltration. A second biopsy performed 14 days after transplantation showed a dense mononuclear cell infiltrate with a preferential loss of insulin-staini ng cells relative to glucagon-staining cells in the islets. These data are consistent with recurrent autoimmune diabetes in an isolated isle t allograft in an immunosuppressed type I diabetic recipient. In addit ion, this forearm subfascial site may be a useful means to monitor isl et rejection and autoimmune recurrence in therapeutic intraportal isle t allografts.