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Islet Transplantation

  • Neil W. A. McGowan
  • Laura Bailey
  • John J. CaseyEmail author
Chapter
Part of the Springer Surgery Atlas Series book series (SPRISURGERY)

Abstract

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 [1], 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% [2].

Keywords

Pancreatic islets Type 1 diabetes mellitus Hypoglycaemia 

References

  1. 1.
    Shapiro AM, Lakey JR, Ryan EA, Korbutt GS, Toth E, Warnock GL, et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med. 2000;343:230–8.CrossRefGoogle Scholar
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    Barton FB, Rickels MR, Alejandro R, Hering BJ, Wease S, Naziruddin B, et al. Improvement in outcomes of clinical islet transplantation: 1999–2010. Diabetes Care. 2012;35:1436–45.CrossRefGoogle Scholar
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    Ricordi C, Lacy PE, Scharp DW. Automated islet isolation from human pancreas. Diabetes. 1989;38(Suppl 1):140–2.CrossRefGoogle Scholar
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    Owen RJ, Ryan EA, O’Kelly K, Lakey JR, McCarthy MC, Paty BW, et al. Percutaneous transhepatic pancreatic islet cell transplantation in type 1 diabetes mellitus: radiologic aspects. Radiology. 2003;229:165–70.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Neil W. A. McGowan
    • 1
  • Laura Bailey
    • 2
  • John J. Casey
    • 3
    Email author
  1. 1.Department of Tissues and Cells DirectorateScottish National Blood Transfusion ServiceEdinburghUK
  2. 2.Scottish National Blood Transfusion Service, Cellular Therapy Development Centre, MRC Centre for Regenerative MedicineThe University of Edinburgh BioQuarterEdinburghUK
  3. 3.Edinburgh Transplant CentreRoyal Infirmary of Edinburgh, University of EdinburghEdinburghUK

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