Article Text

PDF
Islet cell transplantation
  1. P Srinivasan,
  2. G C Huang,
  3. S A Amiel,
  4. N D Heaton
  1. King’s College London School of Medicine at King’s College Hospital, Institute of Liver Studies and Diabetes Research Group, King’s College Hospital, London, UK
  1. Correspondence to:
 Professor N D Heaton
 Institute of Liver Studies, Kings College Hospital, Denmark Hill, London, SE5 9RS, UK; nigel.heaton{at}kingsch.nhs.uk

Abstract

People with type 1 diabetes have normal exocrine pancreatic function, making islet cell rather than whole organ transplantation an attractive option. Achieving insulin independence in type 1 diabetes was the perceived goal of islet cell transplantation. The success of the Edmonton group in achieving this in a selected group of type 1 patients has led to renewed optimism that this treatment could eventually replace whole organ pancreas transplantation. However the long-term results of this treatment indicate that insulin independence is lost with time in a significant proportion of patients, although they may retain glycaemic stability. In this context, the indications for islet cell transplantation, which have evolved over the last 5 years, indicate that the patients who benefit most are those who experience severe hypoglycaemic reactions despite optimal insulin therapy. This review will summarise the history of islet cell transplantation, islet isolation techniques, the transplant procedure, immunosuppressive therapy, indications for islet cell transplantation, current clinical trials, the early UK islet cell transplant experience using the Edmonton protocol, and some of the challenges that lie ahead.

  • ACE, angiotensin-converting enzyme
  • ADA, American Diabetes Association
  • BMI, body mass index
  • DCCT, Diabetes Control and Complications Trial
  • ETDRS, Early Treatment Diabetic Retinopathy Study
  • IBMIR, instant blood mediated inflammatory reaction
  • IEQ, islet equivalents
  • MMF, mycophenolate mofetil
  • PFCs, perfluorohydrocarbons

Statistics from Altmetric.com

Footnotes

  • Competing interests: None declared

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.