that decisions regarding the application of whole pancreas transplantation would have been considered for some recipients of a functioning kidney allograft.

Host Autoimmune Responses to Transplanted Islets. The immune response to transplanted islets and autoantigen has been measured in recipients with functioning and failing islet allografts. One-year islet allograft survival in recipients with positive autoantibodies (GAD65 or ICA) before or after their transplant compared unfavorably with survival in recipients who remained autoantibody-negative.75 The clinical relevance of autoimmunity after islet transplants was confirmed by another study: insulin independence was achieved in >60% of recipients without, but not in any recipients with, autoantibody elevations.76 The study by Bosi et al76 also identified glutamic acid decarboxylase (GAD) as the key autoantigen in the reexposure of patients with autoimmune diabetes to islet beta cells. Recurrent autoimmunity was independent of donor-recipient HLA matching and autoantibody titer at the time of the transplant; autoimmunity also recurred in the absence of alloimmunity.

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