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State of the Art of Clinical Islet Transplantation and Novel Protocols of Immunosuppression

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Abstract

Clinical islet transplantation has transitioned from curiosity to realistic therapy over the past decade. An estimated 750 patients have undergone intraportal islet-alone transplantation over this period, and a smaller subset received combined islet-kidney transplants. The primary benefit of successful islet transplantation has been to eliminate severe, recurrent hypoglycemia, a problem that has been hard to eliminate by other means in 15% of those with type 1 diabetes. The secondary benefit of independence from insulin has attracted patients, but has had limited sustainability previously, especially with a single-donor graft, but recent results from four independent centers suggest marked improvement in long-term outcome, with 5-year results now approximating solitary pancreas transplantation. Emerging data confirm that islet transplantation can stabilize and reverse several secondary diabetic complications similar to whole pancreas transplantation, but larger, head-to-head trials are needed to compare islet transplantation with best medical therapies. Current goals are to extend durability, and to make islet transplantation more widely available for patients in need. Governmental and health insurance providers in several countries now reimburse islet transplantation as part of clinical care. As the safety of the procedure and of adjunctive immunosuppressive therapies improve, and benefit accrues over potential risk, islet transplantation will be offered earlier in the course of the disease, including newly diagnosed children. The role of islet transplantation in type 2 diabetes has yet to be defined. We review the current status of islet transplantation, and discuss current and future immunosuppressive protocols that will pave the way to more broad application of cellular replacement in diabetes.

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Acknowledgments

A.M.J. Shapiro is supported by a Senior Clinical Scholarship from Alberta Innovates-Healthcare Solutions. Grant support for clinical trials has been provided by the CIT through the National Institutes of Health divisions of the National Institute of Allergy and Immunological Disease and the National Institute of Diabetes and Digestive Disease and Kidney, from a major center grant from the Juvenile Diabetes Research Foundation, and from the Diabetes Research Foundation of Canada. A.M.J. Shapiro is a member of the Alberta Diabetes Institute.

Disclosure

Conflicts of interest: A.M.J. Shapiro is a board member of the Diabetes Research Institute Foundation of Canada, and has been a consultant for Sernova Inc. and Viacyte Inc.

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  1. Clinical Islet Transplant Program, University of Alberta, 2000 College Plaza, 8215 112th Street, Edmonton, AB, T6G 2C8, Canada

    A. M. James Shapiro

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Shapiro, A.M.J. State of the Art of Clinical Islet Transplantation and Novel Protocols of Immunosuppression. Curr Diab Rep 11, 345–354 (2011). https://doi.org/10.1007/s11892-011-0217-8

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