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Sustained Islet Allograft Function After Peritransplant Treatment Using Exenatide With and Without Everolimus.

Islet transplantation represents now a feasible therapeutical option for selected patients with brittle type 1 diabetes mellitus. Islet graft function has progressively improved over time with a success rate in some centers similar to that of whole pancreas transplantation. The first phases after transplantation appear to be critical. Transplanted islets are exposed to an inflammatory reaction that, together with glucotoxicity in the case of suboptimal glycemic control results in significant reduction of cellular vitality. For these reasons, different protocols of recipient treatment were proposed, such as anti-inflammatory drugs or long-acting glucagon-like peptide 1 analogues to improve insulin secretion and overall metabolic balance. The mammalian target of rapamycin inhibitors in particular have a significant antiinflammatory effect; in comparison to sirolimus, everolimus proved to have a most potent effect, higher bioavailability, and a shorter half-life. Ten patients affected by type 1 diabetes mellitus (7 with brittle diabetes and 3 already under immunosuppression therapy for a previous kidney transplantation) were treated for 1 month after intrahepatic islet allotransplantation with low-dose exenatide 5 μg twice/day and 6 of them with everolimus 3 mg 12 hours before and 12 to 18 hours after the first islet transplantation, too. The immunosuppression therapy included induction with polyclonal ALG (or Basiliximab in