Surgical treatment of diabetes mellitus by islet cell and pancreas transplantation
- Department of Transplantation Surgery, University of Leicester
- Mr S A White, Department of Surgery, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK
- Received 24 January 2000
- Accepted 22 June 2000
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.2With these factors in mind investigators have tried to isolate and transplant individual islet of Langerhans cells.
Box 1: Chronic diabetic complications
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Nephropathy.
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Neuropathy.
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Retinopathy.
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Peripheral vascular disease.
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Coronary artery disease.
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Cerebrovascular disease.
Box 2: Pancreas transplantation
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Major surgical procedure.
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Higher rate of morbidity and mortality.
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Need for immunosuppression.
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Improves quality of life.
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Reverses some diabetic complications.
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82% insulin independent at one year.
Box 3: Islet transplantation
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Minor radiological procedure.
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Low morbidity and mortality.
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Intrahepatic implantation.
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Potential for no immunosuppression.
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Potential for use in young newly diagnosed diabetic patients.
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14% insulin independent at one year.
The advantages of islet cell transplantation (box 3) are that it requires only local anaesthesia and is a minor radiological procedure having minimal risk to the patient. Unfortunately the merits of both pancreas and islet cell transplantation have to be weighed against the need for immunosuppression and for those patients having a pancreas transplant the risk of the surgical procedure.3 For patients who survive a pancreas transplant some of these risks are offset by the improved …
