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Necessities for a Clinical Islet Program

  • Wayne J. HawthorneEmail author
Chapter
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 938)

Abstract

For more than two decades we have been refining advances in islet cell transplantation as a clinical therapy for patients suffering from type 1 diabetes. A great deal of effort has gone to making this a viable therapy for a broader range of patients with type 1 diabetes. Clinical results have progressively improved, demonstrating clinical outcomes on par with other organ transplants, specifically in terms of insulin independence, graft and patient survival. We are now at the point where islet cell transplantation, in the form of allotransplantation, has become accepted as a clinical therapy in adult patients affected by type 1 diabetes, in particular those suffering from severe hypoglycaemic unawareness. This chapter provides an overview on how this has been undertaken over the years to provide outcomes on par with other organ transplantation results. In particular this chapter focuses on the processes and facilities that are required to establish a clinical islet isolation and transplantation program. It also outlines the very important underpinning processes of selection of the organ donor for islet isolation, the processes of organ donor operation and preservation of the pancreas by various means and the ideal ways to best improve outcomes for human islet cell isolation. Providing these more optimal conditions we can underpin the isolation processes to provide islets for transplantation and as such a safe, effective and feasible therapeutic option for an increasing number of patients suffering from type 1 diabetes with severe hypoglycaemic unawareness.

Keywords

Diabetes Insulin Islet Islet cell Islet cell allotransplantation Islet cell autotransplantation Islet cell isolation Islet equivalent (IEQ), type 1 diabetes (T1D) 

Abbreviations

BMI

Body mass index

CIT

Cold ischaemic time

CMRL

Connaught Medical Research Laboratories

CS

Celsior

HTK

Histidine-tryptophan-ketoglutarate

IEQ

Islet cell isolation, islet equivalent

IEQ/g

Islet equivalents per gram

MTC

Mixed treatment comparison

QALY

Quality-adjusted life years

SPK

Simultaneous pancreas and kidney

T1D

Type 1 diabetes

UW

University of Wisconsin solution

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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.National Pancreas and Islet Transplant LaboratoriesThe Westmead Institute for Medical ResearchWestmeadAustralia
  2. 2.Department of Surgery, Westmead Clinical School, Westmead HospitalUniversity of SydneyWestmeadAustralia

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