Evidence of recurrent type 1 diabetes following HLA-mismatched pancreas transplantation

Type 1 diabetes mellitus is considered as an autoimmune disease against bet a cells. Diabetes recurrence after pancreas transplantation is well known i n HLA-identical twins while it is rarely reported in recipients of cadaveri c pancreatic grafts. In the present case report, diabetes recurrence occurred in a recipient who underwent cadaveric combined pancreas kidney transplantation. Seven years after transplantation the patient exhibited progressive hyperglycemia needi ng insulin therapy while the renal graft was well functioning. The diagnosi s of recurrent disease was obtained on the histological features such as se lective loss of beta cells without clear signs of insulitis and on the pres ence of markers (GAD 65 and 1A-2) for humoral autoimmunity. It is intriguing that, at the time of recurrence of type 1 diabetes, the pa tient had stopped steroids and azathioprine, while only cyclosporine was ma intained as immunosuppressive treatment. Our case report underlines the relevance of studying the humoral autoimmune response directed to islet autoantigens in cadaveric pancreas allograft re cipients. Furthermore, it suggests that an efficient immunosuppressive trea tment after transplantation may be able to reduce the autoimmune response a gainst the pancreatic allograft.