Autoimmune diabetes recurrence should be routinely monitored after pancreas transplantation

Abstract

Autoimmune type 1 diabetes recurrence in pancreas grafts was first described 30 years ago, but it is not yet completely understood. In fact, the number of transplants affected and possibly lost due to this disease may be falsely low. There may be insufficient awareness to this entity by clinicians, leading to underdiagnosis. Some authors estimate that half of the immunological losses in pancreas transplantation are due to autoimmunity. Pancreas biopsy is the gold standard for the definitive diagnosis. However, as an invasive procedure, it is not the ideal approach to screen the disease. Pancreatic autoantibodies which may be detected early before graft dysfunction, when searched for, are probably the best initial tool to establish the diagnosis. The purpose of this review is to revisit the autoimmune aspects of type 1 diabetes and to analyse data about the identified autoantibodies, as serological markers of the disease. Therapeutic strategies used to control the disease, though with unsatisfactory results, are also addressed. In addition, the author’s own experience with the prospective monitoring of pancreatic autoantibodies after transplantation and its correlation with graft outcome will be discussed.

Keywords: Autoantibodies, Autoimmune type 1 diabetes, Pancreas transplantation, Type 1 diabetes recurrence

Core tip: Recurrence of pancreatic autoantibodies after kidney-pancreas transplantation is a disturbing finding. It was estimated that half of the immunological losses of pancreas grafts may be due to autoimmunity. There is a rising investigational effort concerning this issue. At our unit, we have designed a protocol of prospective monitoring of pancreatic autoantibodies after transplantation. In our experience, patients with positive pancreatic autoantibodies, compared to negative patients, were more likely to present higher HbA1c and lower C-peptide levels. A review of the most important publications in this field, and about the interest of pancreatic autoantibodies monitoring after transplantation, was made.