Diabetes

22 May 2009

Pancreatic islet transplantation

The rationale behind pancreatic islet transplantation is the provision of islet cells that produce insulin and which can sense blood-glucose levels.

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The rationale behind pancreatic islet transplantation is the provision of islet cells that produce insulin and which can sense blood-glucose levels.

In theory, it appears to be ideal in treating type 1 diabetics who have little or no insulin production.

However, problems encountered in pancreatic islet transplantation are:

  • inadequate number of viable islet cells that are transplanted
  • adequacy of engraftment of transplanted islet cells in the liver
  • adequacy of immune suppression
  • destruction of islet cells by the original immune process that caused type 1 diabetes

Studies show that 80% of islet-transplant patients don't require exogenous insulin after one year of transplantation, but this number drops to 10% after five years. This raises concerns about the sustained efficacy of islet transplantation.

Both the United States and Canada boast centres that perform islet transplantation. Pancreatic islet transplantation is currently indicated for type 1 diabetics who are to undergo kidney transplantation and diabetics who experience frequent hypoglycaemic episodes of which they are unaware.

Reviewed by Dr Suresh Rajpaul (MbChB, FCPsa)
May 2009

 

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