Combined Pancreatic Islet and Kidney Transplantation in a Child With Unstable Type 1 Diabetes and End‐Stage Renal Disease

• Published in: American journal of transplantation Vol. 13; no. 8; pp. 2207 - 2210
• Main Authors: Benedict, K. A., Moassesfar, S., Adi, S., Gitelman, S. E., Brennan, J. L., McEnhill, M., Stock, P. G., Portale, A. A., Posselt, A. M.
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley 01.08.2013; Elsevier Limited
• Subjects: Adult; Biological and medical sciences; Blood Glucose - analysis; Child; Diabetes; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - surgery; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; General aspects; Humans; Islet transplantation; Kidney diseases; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - surgery; Kidney Transplantation; Male; Medical sciences; Pancreas Transplantation; pediatric; Prognosis; renal disease; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Transplants & implants; type I diabetes; Endocrinopathy; Pediatrics; Chronic renal failure; Homograft; Autoimmune disease; Multiorgan transplantation; Homotransplantation; Kidney; renal disease; pediatric; Combined surgery; Surgery; Islet transplantation; Graft; Child; type I diabetes; Endocrine pancreas; Human; Kidney disease; Immunopathology; Urinary system disease; Langerhans islet; Nephropathy; Treatment; Urinary system; Type 1 diabetes; Renal failure; Instability; Kidney transplantation; kidney transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.12323

Islet transplantation after successful kidney transplantation is a recognized treatment for adults with diabetes and end‐stage renal disease (ESRD), but has not been considered an option in the pediatric population. To our knowledge, we report the first combined islet and kidney transplant in a child. The patient was born with bilateral renal hypoplasia and was diagnosed with type 1 diabetes mellitus at age 13 months. He had erratic glycemic control and hypoglycemia unawareness. At 6 years of age, the child safely underwent simultaneous islet and live donor kidney transplantation. Although function of the islet graft was transient, the combined transplant provided significant benefits in terms of glucose control and overall growth and development. Such an approach represents a viable treatment option for pediatric patients with ESRD and unstable diabetes. The authors present the clinical course of a 6‐year‐old patient with type I diabetes mellitus and congenital end‐stage renal disease who underwent a simultaneous live donor kidney and deceased donor islet transplant.