A worldwide survey of activities and practices in clinical islet of Langerhans transplantation
Thierry Berney1, Axel Andres1, Melena D. Bellin2, Eelco J.P. de Koning3, Paul R.V. Johnson4, Thomas W.H. Kay5, Torbjörn Lundgren6, Michael R. Rickels7, Hanne Scholz8, Steve White9, Peter G. Stock10.
1Division of Transplantation, Department of Surgery, University of Geneva Hospitals, Geneva, Switzerland; 2Departments of Pediatrics and Surgery, University of Minnesota Medical Center, Minneapolis, MN, United States; 3Department of Medicine, Leiden University Medical Center, Leiden, Netherlands; 4Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom; 5Department of Medicine, St. Vincent’s Institute of Medical Research, Melbourne, Australia; 6Department of Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden; 7Division of Endocrinology, Diabetes & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States; 8Department of Transplant Medicine and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway; 9Department of HPB and Transplant Surgery, The Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; 10Division of Transplantation, Department of Surgery, University of California at San Francisco, San Francisco, CA, United States
The international islet transplant centers. EPITA (European Pancreas and Islet Transplant Association). IPITA (International Pancreas and Islet Transplant Association).
Background: The lack of a comprehensive international islet transplantation registry has prevented full visibility of worldwide islet transplantation activity.
Methods: A global online survey was administered to 69 islet transplantation programs, covering 84 centers and 5 networks, using Microsoft Forms. The survey addressed questions on program organization and activity in the 2000- 2020 period, including impact on activity of national health care coverage policies. Impact of the COVID pandemic was also addressed. Activity data from non-responding or not contacted centers were obtained from the CITR or other sources.
Results: The survey response rate was 88%. We obtained full data from 55 institutions or networks worldwide and basic activity data from 6 centers. Additional data were obtained from alternative sources. A total of 94 institutions and 5 networks was finally identified as having performed islet allotransplantation. 4’321 islet allotransplants (2,565 in Europe, 1,475 in North America, 135 in Asia, 119 in Oceania, 28 in South America) were reported in 2’149 patients in the survey period. From 15 centers active at the start of the study period, the number of simultaneously active islet centers peaked at 54, to progressively decrease to 26 having performed islet allotransplants in 2020. Notably, only 16 centers/networks have done >100 islet allotransplants in the survey period. Types of transplants performed differed notably between North America and the rest of the world, in particular with respect to the near-absence of simultaneous islet-kidney transplantation and the significant number of centers performing only islet autotransplants. Absence of heath care coverage has significantly hampered transplant activity in the past years and the COVID-19 pandemic in 2020.
Conclusions: This comprehensive survey was able to quantify islet transplant allotransplantation in the last 2 decades and identify differences in activity and practices in different world regions.
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