A Worldwide Survey of Activities and Practices in Clinical Islet of Langerhans Transplantation

Abstract

A global online survey was administered to 69 islet transplantation programs, covering 84 centers and 5 networks. The survey addressed questions on program organization and activity in the 2000-2020 period, including impact on activity of national health care coverage policies. We obtained full data from 55 institutions or networks worldwide and basic activity data from 6 centers. Additional data were obtained from alternative sources. A total of 94 institutions and 5 networks was identified as having performed islet allotransplantation. 4,365 islet allotransplants (2,608 in Europe, 1,475 in North America, 135 in Asia, 119 in Oceania, 28 in South America) were reported in 2,170 patients in the survey period. From 15 centers active at the start of the study period, the number of simultaneously active islet centers peaked at 54, to progressively decrease to 26 having performed islet allotransplants in 2020. Notably, only 16 centers/networks have done >100 islet allotransplants in the survey period. Types of transplants performed differed notably between North America and the rest of the world, in particular with respect to the near-absence of simultaneous islet-kidney transplantation. Absence of heath care coverage has significantly hampered transplant activity in the past years and the COVID-19 pandemic in 2020.

Keywords: IAK; ITA; SIK; activity; health care coverage; indications; islet transplantation; type 1 diabetes mellitus.

FIGURE 1

Geographic location and activity status of 94 institutions performing or having performed allogeneic islet transplantation (2000–2020). (A) Europe; (B) North America; (C) “Rest of the World”. Green marker: active centers; Blue marker: active centers without activity in 2020; Purple marker: activity on hold; Red marker: activity terminated; Black marker: current status unknown.

FIGURE 2

Islet allotransplant activity of 94 institutions/networks performing or having performed islet transplantation (2000–2020). (A) Europe; (B) North America; (C) “Rest of the World”. Green marker: ≥100 transplants performed; Blue marker: 50–99 transplants performed; Yellow marker: 10–49 transplants performed; Red marker: <10 transplants performed.

FIGURE 3

Continental/regional distribution of islet allotransplant activities (2000–2020). Surface of color disks is proportional to number of transplants performed.

FIGURE 4

Evolution over time of islet transplant center activities.  Cumulative number of centers.  Number of centers that did not terminate their program.  Number of active centers (program not “on hold”).  Number of centers having performed at least 1 islet allotransplant procedure in 2020.

FIGURE 5

Types of transplants performed by center/network. (A) Europe; (B) North America; (C) “Rest of the World”.

FIGURE 6

Types of transplants performed: continental distribution. (A) Proportion of centers in each region having performed IAK (blue), ITA (red) or SIK (green). (B) Proportion of centers in each region by overall preferred types of transplants; blue: IAK only, red: ITA only, green: ITA and IAK, ochre: SIK only, turquoise: IAK, ITA and SIK, light green: ITA and SIK, black: IAK and SIK.