Effective treatment of diabetes, improved quality of life and accelerated cognitive development after pancreas transplantation in a child with type 1 diabetes and allergy to manufactured insulin preparations
Anna Adamusiak1, Karthik Ramanathan1, Tracy Moe1, Melena Bellin1, Raja Kandaswamy1.
1Transplantation, University of Minnesota, Minneapolis, MN, United States
Introduction: Pancreas transplantation in children is uncommon. Limited case series describe simultaneous kidney and pancreas transplants (SPK) in teenagers with type 1 diabetes and diabetic nephropathy. In the absence of indications for kidney transplantation pancreas alone transplantation (PTA) can be considered in a selected group of patients. The youngest documented recipient of PTA was 11 years old, but the graft lasted only for 6 months. Here we present the youngest PTA recipient with one-year graft survival.
Methods: A 13 years old diabetic girl with hypoglycemia unawareness and documented treatment-refractory allergy to available insulin preparations underwent a solitary pancreas transplant. Prior to the pancreas transplantation, she was receiving short-acting insulin with an increasing need for antihistamines and steroids which was negatively impacting her cognitive and social development. Her diabetes was poorly controlled and her quality of life was progressively worsening.
Results: Having the transplant she recovered well from surgery and achieved euglycemia without the need for exogenous insulin. She had two biopsy-proven episodes of acute cellular rejection successfully treated. Her cognitive development accelerated and her quality of life improved which positively her family's overall wellbeing.
Conclusions: This is the youngest, reported in the literature, pancreas transplant recipient with over one-year graft survival. Pancreas transplant alone in a teenager without indications for kidney transplantation could be considered as a last resort treatment of diabetes. The need for lifelong immunosuppression may be a reasonable trade-off in the rare scenario of failed insulin therapy and pancreas transplant is a feasible treatment modality in patients with refractory insulin allergy with no available alternatives.
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