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

2. Protocol Steroid Free CAMPATH 1H (Alemtuzemab) Tacrolimus
Mycophenolate

3. 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 Journal of Clinical Investigation 98:

4. 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

5. 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)

6. 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

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

8. Fasting Glucose

9. HbA1c