LONG-TERM (GREATER-THAN-3-YEAR) INSULIN INDEPENDENCE IN A PATIENT WITH PANCREATIC-ISLET CELL TRANSPLANTATION FOLLOWING UPPER ABDOMINAL EXENTERATION AND LIVER REPLACEMENT FOR FIBROLAMELLAR HEPATOCELLULAR-CARCINOMA

In the University of Pittsburgh experience, the most successful settin g for human islet allografts is in patients undergoing upper abdominal exenteration with total pancreatectomy and liver transplantation for the indication of malignancy (cluster). In this group of patients 6/11 were insulin-independent for long periods. We report herein the metab olic course or the longest survivor (>3 years). This patient has been free of exogenous insulin since the third postoperative month and has sustained her body weight without total parenteral nutrition since the 4th postoperative month. The patient has some postprandial hyperglyce mia but average capillary glucoses are near-normal to normal as are gl ycosylated hemoglobin values. The clearance of glucose during the admi nistration of an intravenous glucose load has been well preserved and is currently normal. C-peptide stimulates significantly in response to intravenously injected glucose. The absolute levels of stimulation du ring the test have declined possibly related to improvements in renal function, decreased immunosuppression or the natural history of cells transplanted into the portal site. The kinetics of the C-peptide respo nse to intravenously injected glucose shows a persistent abnormality o f first-phase insulin release and a prolonged second phase release. Ba sal glucagon levels are low but stimulate to a mixed meal. This patien t's results demonstrate long-term function of islet cells from a singl e donor transplanted into the portal vein using FK506 as an immunosupp ressant agent.