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Resolution of Neurotoxicity and -Cell Toxicity in an Islet Transplant Recipient Following Substitution of Tacrolimus With MMF

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Abstract:

Calcineurin inhibitors such as tacrolimus have well-recognized efficacy in organ transplantation but side effects of nephrotoxicity, neurotoxicity, and -cell toxicity that can be particularly detrimental in islet transplantation. Neuro- and nephrotoxicity have been demonstrated in multiple islet transplant recipients despite the relatively low serum maintenance levels typically used (3–5 ng/ml). We describe a single patient in whom symptoms and signs of neurotoxicity necessitated substitution of tacrolimus with mycophenolate mofetil (MMF), which resulted in complete symptom resolution over the subsequent 9 months. Concomitantly noted were an almost immediate improvement in glycemic control and an improved response to stimulation testing, suggesting remission of tacrolimus-induced -cell toxicity and insulin resistance. At 18 months post-“switch,” 30 months posttransplant, the patient remains insulin independent with good glycemic control. The goal to remove calcineurin inhibitors from regimens of islet transplantation is a worthy one.

Keywords: Function; Islet; Neurotoxicity; Tacrolimus; Transplantation; -Cell toxicity

Document Type: Research Article

DOI: http://dx.doi.org/10.3727/000000006783981639

Affiliations: 1: Diabetes Research Institute, University of Miami School of Medicine, Miami, FL 33136, USA, Department of Surgery, University of Miami School of Medicine, Miami, FL 33136, USA 2: Diabetes Research Institute, University of Miami School of Medicine, Miami, FL 33136, USA 3: Diabetes Research Institute, University of Miami School of Medicine, Miami, FL 33136, USA, Department of Medicine, University of Miami School of Medicine, Miami, FL 33136, USA

Publication date: July 1, 2006

More about this publication?
  • Cell Transplantation publishes original, peer-reviewed research and review articles on the subject of cell transplantation and its application to human diseases. To ensure high-quality contributions from all areas of transplantation, separate section editors and editorial boards have been established. Articles deal with a wide range of topics including physiological, medical, preclinical, tissue engineering, and device-oriented aspects of transplantation of nervous system, endocrine, growth factor-secreting, bone marrow, epithelial, endothelial, and genetically engineered cells, among others. Basic clinical studies and immunological research papers are also featured. To provide complete coverage of this revolutionary field, Cell Transplantation will report on relevant technological advances, and ethical and regulatory considerations of cell transplants. Cell Transplantation is now an Open Access journal starting with volume 18 in 2009, and therefore there will be an inexpensive publication charge, which is dependent on the number of pages, in addition to the charge for color figures. This will allow work to be disseminated to a wider audience and also entitle the corresponding author to a free PDF, as well as prepublication of an unedited version of the manuscript.

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