Review
Surgical treatment of diabetes mellitus by islet cell and pancreas transplantation
S A White, R Kimber, P S Veitch, M L NicholsonDepartment of
Transplantation Surgery, University of Leicester
Correspondence to: Mr S A White, Department of Surgery, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
Submitted 24 January
2000;
Accepted 22 June 2000
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Introduction |
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The incidence and progression of chronic diabetic complications can be reduced by achieving normoglycaemia (box 1). Unfortunately the recent Diabetes Control and Complications Trial has shown that intensive, subcutaneous insulin regimens that improve blood glucose control puts the patient at three times the risk of developing severe hypoglycaemia.1 Intensive subcutaneous insulin regimens can never mimic the physiological fluctuations of in vivo insulin secretion. An alternative option to achieve near normoglycaemia is by transplantation of the whole pancreas (vascularised pancreas transplantation). Some would argue that this is perhaps a cumbersome approach when only the islet cells are needed to restore physiological levels of blood glucose, but perhaps more importantly pancreas transplantation (box 2) has an appreciable high rate of morbidity and mortality compared with kidney transplantation alone.2 With these factors in mind investigators have tried to isolate and transplant individual islet of Langerhans cells.
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The advantages of islet cell transplantation (box
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