Islet transplantation is a minimally invasive procedure for the treatment of type 1 diabetic patients with recurrent severe hypoglycaemia and impaired awareness of hypoglycaemia (IAH). Islet transplant alone (ITA) is most commonly performed, but some patients with a functioning renal transplant may benefit from a subsequent islet graft (islet after kidney, IAK). Patient outcomes following islet transplantation drastically improved following publication of the Edmonton Protocol in 2000 , which reported insulin independence following this procedure in seven consecutive patients with type 1 diabetes. The success of this protocol was attributed to the use of a glucocorticoid-free immunosuppression regimen consisting of sirolimus, low-dose tacrolimus, and daclizumab, in combination with infusion of an adequate islet mass (cumulative dose of 2–3 transplants per patient). Over 1000 patients have now received islet grafts with reversal of IAH in almost all patients and insulin independence reported in 50–90% .
KeywordsPancreatic islets Type 1 diabetes mellitus Hypoglycaemia