RECURRENCE OF IMMUNOLOGICAL MARKERS FOR TYPE-1 (INSULIN-DEPENDENT) DIABETES-MELLITUS IN IMMUNOSUPPRESSED PATIENTS AFTER PANCREAS TRANSPLANTATION

Background Type 1 (insulin dependent) diabetes mellitus (IDDM) is an a utoimmune disease in which autoantibodies against islet cells develop concomitantly with or even preceding diagnosis. Because the recurrence of diabetes can be the cause of graft failure in patients with pancre as transplantation, we studied the possible recurrence of IDDM immunom arkers after transplantation. Methods. The following determinations we re performed every 1-2 years after transplantation in 50 immunosuppres sed IDDM patients with simultaneous kidney and pancreas transplantatio n (bladder drainage of exocrine secretion): islet cell antibodies (ICA ) by direct immunofluorescence, antibodies against glutamic acid decar boxylase (GADab) by radiobinding assay, and the oral glucose tolerance test. The mean follow-up was 4.1+/-6.3 (range 1 to 9 years). Results. GADab were detected in 11 patients after transplantation, 10 of whom had been positive beforehand. ICA reappearance after transplantation w as detected in seven patients (14%). The presence of ICA was related t o GADab positivity (P=0.001) and HLA DR3 patients (P=0.04), but not wi th pancreatitis and rejection episodes, immunosuppression induction th erapy, or donor HLA haplotype. During follow-up, an abnormal oral gluc ose tolerance test was more frequent in ICA-positive patients (P=0.02) , with no differences in metabolic control or insulin secretion. Concl usion. We conclude that GADab persist and ICA reappear despite immunos uppressive therapy in patients with functioning pancreas transplants. The relevance and the risk that this implies for IDDM development shou ld be determined.