Islet cell alloautotransplantation 12 years after simultaneous pancreas-kidney transplantation

Late enteric bleeding in the setting of simultaneous pancreas-kidney transplantation is an uncommon but perhaps underrecognized complication that can result in major morbidity. There are significant challenges both in the diagnosis and management of this complication, and in certain circumstances, graft pancreatectomy of an otherwise functioning graft may be required. Here we present the case of a 49-year-old simultaneous pancreas-kidney transplant recipient who presented 12 years after transplant with recurrent life-threatening enteric bleeding that required a graft pancreatectomy. After pancreatectomy, islets were isolated from the allograft-190 000 islet equivalents with 90% viability and 27% purity. The islets were transplanted back into the recipient percutaneously via the portal vein, with detectable C-peptide 6 weeks after procedure and no hypoglycemic unawareness. A second allogeneic islet cell transplant was subsequently performed two months later, with the patient's latest C-peptide of 430 pmol/L, having maintained good renal function. Alloautotransplantation is a potential treatment option for patients that require graft pancreatectomy and has the advantage of preserving some beta-cell function while not necessitating additional immunosuppression.