Current Diabetes Reports

, Volume 13, Issue 5, pp 713–722

Biologic Agents in Islet Transplantation

  • Boris Gala-Lopez
  • Andrew R. Pepper
  • A. M. James Shapiro
Transplantation (A Pileggi, Section Editor)


Islet transplantation is today an accepted modality for treating selected patients with frequent hypoglycemic events or severe glycemic lability. Despite tremendous progress in islet isolation, culture, and preservation, clinical use is still restricted to a limited subset, and lifelong immunosuppression is required. Issues surrounding limited islet revascularization and immune destruction remain. One of the major challenges is to prevent alloreactivity and recurrence of autoimmunity against β-cells. These two hurdles can be effectively reduced by immunosuppressive therapy combining induction and maintenance treatments. The introduction of highly potent and selective biologic agents has significantly reduced the frequency of acute rejection and has prolonged graft survival, while minimizing the complications of this therapeutic scheme. This review will address the most important biological agents used in islet transplantation. We provide a historical perspective of their introduction into clinical practice and their role in current clinical protocols, aiming at improved engraftment efficiency, increased long-term survival, and better overall results of clinical islet transplantation.


Islet transplantation Immunosuppression Biologic agents Antibodies Induction strategies Maintenance schemes Immune response Acute rejection Graft survival 

Abbreviation list


Islet transplant




Intercellular Adhesion Molecule-1




Type 1 diabetes mellitus


Calcineurin inhibitor


mycophenolate mofetil


mammalian target of rapamycin


Anti-thymocyte globulin


Immunoglobulin G1


Cytotoxic T-lymphocyte antigen 4


Leukocyte Function Antigen


Monoclonal antibody


T-cell receptor


BAAF receptor


Glucagon-like peptide 1


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Boris Gala-Lopez
    • 1
  • Andrew R. Pepper
    • 1
  • A. M. James Shapiro
    • 1
    • 2
  1. 1.Clinical Islet Transplant Program and Department of SurgeryUniversity of AlbertaEdmontonCanada
  2. 2.Medicine and Surgical OncologyUniversity of AlbertaEdmontonCanada

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