Beta Cell Transplantation Richard Smith Consultant Senior Lecturer Renal Medicine Southmead Hospital Bristol

Protocol Steroid Free CAMPATH 1H (Alemtuzemab) Tacrolimus Mycophenolate

Developed in CAMbridge Department of PATHology Rat monoclonal antibody first used in BMT CAMPATH 1G/M CDR grafted to generate 1H Specifically selected/engineered to achieve ‘optimal’ cytotoxicity Wing, M.G. et al Mechanism of first-dose cytokine-release syndrome by CAMPATH-1H: involvement of CD16 (FcgRIII) and CD11a (LFA-1) on NK cells. 1996 Journal of Clinical Investigation 98: 2819-26

Islet and Pancreas Transplantation in type 1 diabetes mellitus Simultaneous Pancreas Kidney Pancreas After Kidney Pancreas Transplant Alone Islet Transplant Alone Islet After Kidney First patient transplanted Dec 2006 SPK Apr 2008 ITA Transplants performed in Oxford Triage and post-op care in Bristol 94 patients referred for assessment Aug 2009-Jul 2010 56 patients went forward to transplant waiting list 90th patient transplanted 2 weeks ago

The First 50 Patients 28 patients received simultaneous pancreas kidney transplants 16 patients received pancreas transplants alone 6 patients received pancreas after kidney transplants 21% of patients experienced graft thrombosis 13% of patients experienced presumed acute allograft rejection 3 deaths 2 grafts lost (SPK x 1 Kidney still functioning PTA x 1)

26 patients in this series became neutropenic (<1 26 patients in this series became neutropenic (<1.8 x109 cells/L) requiring reduction in mycophenolate dose

Unusual complications Small joint polyarthropathy 4 Hip pain with synovitis 1 Paraparesis 1 NK cell lymphoma 1 AIHA and ITP 1

Fasting Glucose

HbA1c 3 12 24