For Debate

Diabetologia

, Volume 51, Issue 2, pp 227-232

First online:

Optimising islet engraftment is critical for successful clinical islet transplantation

  • O KorsgrenAffiliated withDepartment of Radiology, Oncology and Clinical Immunology, Division of Clinical Immunology, Rudbeck Laboratory, C11, University Hospital Email author 
  • , T LundgrenAffiliated withDepartment of Transplantation Surgery, CLINTEC, Karolinska Institute
  • , M FelldinAffiliated withDepartment of Transplantation, University Hospital
  • , A FossAffiliated withDepartment of Transplantation Surgery, Rikshospitalet-Radiumhospitalet Medical Center
  • , B IsakssonAffiliated withDepartment of Surgery, Karolinska Institute
  • , J PermertAffiliated withDepartment of Surgery, Karolinska Institute
  • , N H PerssonAffiliated withDepartment of Nephrology and Transplantation, University Hospital
  • , E RafaelAffiliated withDepartment of Surgery, Karolinska Institute
  • , M RydénAffiliated withDepartment of Medicine, Karolinska Institute
    • , K SalmelaAffiliated withDivision of Transplantation, Surgical Hospital, Helsinki University
    • , A TibellAffiliated withDepartment of Transplantation Surgery, CLINTEC, Karolinska Institute
    • , G TufvesonAffiliated withDepartment of Surgical Sciences, Division of Transplantation Surgery, University Hospital
    • , B NilssonAffiliated withDepartment of Radiology, Oncology and Clinical Immunology, Division of Clinical Immunology, Rudbeck Laboratory, C11, University Hospital

Abstract

Clinical islet transplantation is currently being explored as a treatment for persons with type 1 diabetes and hypoglycaemia unawareness. Although ‘proof-of-principle’ has been established in recent clinical studies, the procedure suffers from low efficacy. At the time of transplantation, the isolated islets are allowed to embolise the liver after injection in the portal vein, a procedure that is unique in the area of transplantation. A novel view on the engraftment of intraportally transplanted islets is presented that could explain the low efficacy of the procedure.

Keywords

Clinical Engraftment Innate immunity Intraportal Intramuscular Islet transplantation Liver morphology Thrombosis Tumour metastasis Revascularisation