Recurrence of Autoimmune Diabetes Mellitus in Recipients of Cadaveric Pancreatic Grafts

Abstract

Insulin-dependent diabetes mellitus is an autoimmune disease in which the beta cells of the islets of Langerhans are selectively destroyed.¹ In a patient with this disease, a transplanted pancreas should be as susceptible to the autoimmune process as the native pancreas. Indeed, insulin-dependent diabetes mellitus can recur in an immunocompetent or minimally immunosuppressed recipient of a pancreatic transplant from an identical twin or HLA-identical sibling.² Usually, however, the degree of immunosuppression required to prevent rejection is sufficient to prevent autoimmune damage to the pancreatic graft.³ We report on two patients who underwent pancreatic transplantation with poor HLA matching and in whom the beta cells in the transplants were subsequently destroyed despite standard immunosuppressive therapy.