Transplantation Direct (Jun 2023)

Cognitive Outcome After Islet Transplantation

  • Aurélie Mailliez, MD,
  • Camille Ternynck, PhD,
  • Arnaud Jannin, MD,
  • Madleen Lemaître, MD,
  • Benjamin Chevalier, MD,
  • Kristell Le Mapihan, MD,
  • Frédérique Defrance, MD,
  • Marie-Anne Mackowiak, MD,
  • Adeline Rollin, MD,
  • Maanaoui Mehdi, MD,
  • Mikael Chetboun, MD,
  • François Pattou, MD, PhD,
  • Florence Pasquier, MD, PhD,
  • Marie-Christine Vantyghem, MD, PhD

DOI
https://doi.org/10.1097/TXD.0000000000001493
Journal volume & issue
Vol. 9, no. 6
p. e1493

Abstract

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Background. Severe or repeated hypoglycemia events may favor memory complaints in type 1 diabetes (T1D). Pancreatic islet transplantation (IT) is an alternative option to exogenous insulin therapy in case of labile T1D, implying a maintenance immunosuppression regimen based on sirolimus or mycophenolate, associated with tacrolimus, that may also have neurological toxicity. The objective of this study was to compare a cognitive rating scale Mini-Mental State Examination (MMSE) between T1D patients with or without IT and to identify parameters influencing MMSE. Methods. This retrospective cross-sectional study compared MMSE and cognitive function tests between islet-transplanted T1D patients and nontransplanted T1D controls who were transplant candidates. Patients were excluded if they refused. Results. Forty-three T1D patients were included: 9 T1D patients before IT and 34 islet-transplanted patients (14 treated with mycophenolate and 20 treated with sirolimus). Neither MMSE score (P = 0.70) nor higher cognitive function differed between islet versus non–islet-transplanted patients, whatever the type of immunosuppression. In the whole population (N = 43), MMSE score was negatively correlated to glycated hemoglobin (r = –0.30; P = 0.048) and the time spent in hypoglycemia on the continuous glucose monitoring (r = –0.32; P = 0.041). MMSE score was not correlated to fasting C-peptide level, time spent in hyperglycemia, average blood glucose, time under immunosuppression, duration of diabetes, or beta-score (success score of IT). Conclusions. This first study evaluating cognitive disorders in islet-transplanted T1D patients argues for the importance of glucose balance on cognitive function rather than of immunosuppressive treatment, with a favorable effect of glucose balance improvement on MMSE score after IT.