Successful pregnancy and delivery after simultaneous islet‐kidney transplantation

• Published in: American journal of transplantation Vol. 18; no. 8; pp. 2075 - 2078
• Main Authors: Assalino, Michela, Podetta, Michele, Demuylder‐Mischler, Sandrine, Francini, Katyuska, Pernin, Nadine, Randin, Jean‐Pierre, Bosco, Domenico, Andres, Axel, Berney, Thierry
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.08.2018
• Subjects: Adult; Anus; Beta cells; Case reports; clinical research/practice; Diabetes; Diabetes mellitus; Diabetes mellitus (insulin dependent); Diabetes Mellitus, Type 1 - therapy; Female; Fetuses; Health risk assessment; Humans; immunosuppression/immune modulation; Immunosuppressive agents; immunosuppressive regimens; Insulin; Islet cells; islet transplantation; islets of Langerhans; Islets of Langerhans Transplantation - methods; Kidney transplantation; Kidney Transplantation - methods; Kidney transplants; Labor, Obstetric; obstetrics and gynecology; Pancreatic islet transplantation; Pregnancy; Pregnancy Complications - prevention & control; Pregnancy Outcome; type 1; type 1; immunosuppression/immune modulation; clinical research/practice; obstetrics and gynecology; pregnancy; islet transplantation; diabetes; immunosuppressive regimens; islets of Langerhans
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.14884

Allogeneic islet of Langerhans transplantation is a recognized beta‐cell replacement therapy for patients affected by type 1 diabetes mellitus. Type 1 diabetes mellitus is a condition associated with an increased risk of adverse outcomes for pregnant women and fetuses. We report the case of a 29‐year‐old woman with type 1 diabetes mellitus, who underwent successful allogeneic islet transplantation with simultaneous kidney transplantation. She achieved durable insulin independence after 2 islet infusions. Pregnancy was desired and planned 2 years after the last islet infusion. Multidisciplinary monitoring of pregnancy was carried out and the immunosuppressive regimen was adapted. Euglycemia was maintained throughout pregnancy without the need for exogenous insulin. After an uneventful pregnancy, she delivered on term an otherwise healthy male child with imperforate anus that was immediately surgically corrected. In conclusion, allogeneic islet transplantation is a suitable treatment for women of childbearing age with complicated type 1 diabetes mellitus, allowing physiologic glycemic control during pregnancy with a low risk of graft loss. This target can be achieved only by a tight multidisciplinary follow‐up, including immunosuppressive therapy adaptation and adequate diabetes and obstetrical monitoring. A patient who underwent a simultaneous islet‐kidney transplant has an uneventful pregnancy while maintaining euglycemia without exogenous insulin.