Islets of Hope treatment options for persons with diabetes

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Article disclaimer

Reprint of NIH
Publication No. 04–4693; November 2003; Edited for style and content by Lahle Wolfe


You may also be interested in our Research Section which contains information about islet transplant technology and stem cell research


About Pancreas Organ Transplants
From NLM/NIH.gov

The healthy pancreas is obtained from a donor who has suffered brain-death, but remains on life-support. The donor pancreas must meet numerous criteria to make sure it is suitable.  In addition to insulin, the pancreas produces other secretions, such as digestive enzymes, which drain through the pancreatic duct into the duodenum. Therefore, a portion of the duodenum is removed with the donor pancreas. The healthy pancreas is transported in a cooled solution that preserves the organ for up to 20 hours.

The patient's diseased pancreas is not removed during the operation. The donor pancreas is usually inserted in the right lower portion of the patient's abdomen and attachments are made to the patient's blood vessels. The donor duodenum is attached to the patient's intestine or bladder to drain pancreatic secretions.

The operation is usually done at the same time as a kidney transplant in diabetic patients with kidney disease


Site Links Courtesy of KPTransplant

Personal Story about a man that had a kidney and pancreas transplant

Jackson Memorial Hospital
Division of Kidney and Pancreas Transplantation

Diabetes Research Institute at the University of Miami

UNOS Transplantation Information Site

Surviving Transplantation

National Kidney Foundation

TransWeb - Transplantation and Donation

Transplant Medications

The Islet Foundation

National Transplant Assistance Fund

The Insulin-Free World Foundation

Fast Track to a Cure

Diabetes Portal.org

Children with Diabetes.org

The Voice Of The Diabetic-Quarterly Magazine

Diabetes Interview

American Diabetes Association

The International Society For Peritoneal Dialysis

Dialysis Units in the USA

Transplant Buddies

 

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Diabetes treatment options

Pancreatic islet cell transplant


think like a pancreas  Gary Scheiner, CDE
Think Like a Pancreas:
 Many books offer advice on managing diabetes, but few focus specifically on the day-to-day issues facing those who use insulin.  Scheiner, a certified diabetes educator and himself an insulin user himself since 1985, gives you the tools to "think like a pancreas"--that is, to successfully master the art and science of matching insulin to the body’s ever-changing needs. Free of medical mumbo jumbo, comprehensive, and packed with useful information not readily available in other books, Think Like a Pancreas discusses: day-to-day blood glucose control and monitoring, designing an insulin program, measuring insulin to carbohydrate intake and physical activity ,  pluses and minuses of different insulin-delivery  methods, optimal management of diabetes using an insulin pump, hypoglycemia—the best ways to avoid it and treat it , the impact of emotions, stress, illness, and aging , making the best use of your health care team and community resources , plus dozens of other issues that everyone taking insulin needs to understand and master.     IOH Rating 5/5 

Mini Site Index
What is a pancreas?
Islet Functions
Islets Transplantation
Research Developments
Transplantation: Benefits, Risks, and Obstacles
Immunosuppression Drugs

More Information

Also, see Diabetes Research: Pancreas Transplant, Pancreas Organ Transplants and Islet Cell Transplant Research

What is a pancreas?

The pancreas, an organ about the size of a hand, is located behind the lower part of the stomach. It makes insulin and enzymes that help the body digest and use food. Spread all over the pancreas are clusters of cells called the Islets of Langerhans.  Islets are made up of two types of cells: alpha cells, which make glucagon, a hormone that raises the level of glucose (sugar) in the blood, and beta cells, which make insulin.


Islet Functions

Insulin is a hormone that helps the body use glucose for energy. If your beta cells do not produce enough insulin, diabetes will develop. In type 1 diabetes, the insulin shortage is caused by an autoimmune process in which the body's immune system destroys the beta cells.


Islet Transplantation

In an experimental procedure called islet transplantation, islets are taken from a donor pancreas and transferred into another person. Once implanted, the beta cells in these islets begin to make and release insulin. Researchers hope that islet transplantation will help people with type 1 diabetes live without daily injections of insulin.


Research Developments

Scientists have made many advances in islet transplantation in recent years. Since reporting their findings in the June 2000 issue of the New England Journal of Medicine, researchers at the University of Alberta in Edmonton, Canada, have continued to use a procedure called the Edmonton protocol to transplant pancreatic islets into people with type 1 diabetes. A multicenter clinical trial of the Edmonton protocol for islet transplantation is currently under way, and results will be announced in several years. According to the Immune Tolerance Network (ITN), as of June 2003, about 50 percent of the patients have remained insulin-free up to 1 year after receiving a transplant. A clinical trial of the Edmonton protocol is also being conducted by the ITN, funded by the National Institutes of Health and the Juvenile Diabetes Research Foundation International.

Researchers use specialized enzymes to remove islets from the pancreas of a deceased donor. Because the islets are fragile, transplantation occurs soon after they are removed.

During the transplant, the surgeon uses ultrasound to guide placement of a small plastic tube (catheter) through the upper abdomen and into the liver. The islets are then injected through the catheter into the liver. The patient will receive a local anesthetic. If a patient cannot tolerate local anesthesia, the surgeon may use general anesthesia and do the transplant through a small incision. Possible risks include bleeding or blood clots.

It takes time for the cells to attach to new blood vessels and begin releasing insulin. The doctor will order many tests to check blood glucose levels after the transplant, and insulin may be needed until control is achieved.


Transplantation: Benefits, Risks, and Obstacles

The goal of islet transplantation is to infuse enough islets to control the blood glucose level without insulin injections. For an average-size person (70 kg), a typical transplant requires about 1 million islets, extracted from two donor pancreases. Because good control of blood glucose can slow or prevent the progression of complications associated with diabetes, such as nerve or eye damage, a successful transplant may reduce the risk of these complications. But a transplant recipient will need to take immunosuppressive drugs that stop the immune system from rejecting the transplanted islets.

Researchers are trying to find new approaches that will allow successful transplantation without the use of immunosuppressive drugs, thus eliminating the side effects that may accompany their long-term use.

Rejection is the biggest problem with any transplant. The immune system is programmed to destroy bacteria, viruses, and tissue it recognizes as "foreign," including transplanted islets. Immunosuppressive drugs are needed to keep the transplanted islets functioning.


Immunosuppressive Drugs

The Edmonton protocol uses a combination of immunosuppressive drugs, also called antirejection drugs, including dacliximab (Zenapax), sirolimus (Rapamune), and tacrolimus (Prograf). Dacliximab is given intravenously right after the transplant and then discontinued. Sirolimus and tacrolimus, the two main drugs that keep the immune system from destroying the transplanted islets, must be taken for life.

These drugs have significant side effects and their long-term effects are still not known. Immediate side effects of immunosuppressive drugs may include mouth sores and gastrointestinal problems, such as stomach upset or diarrhea. Patients may also have increased blood cholesterol levels, decreased white blood cell counts, decreased kidney function, and increased susceptibility to bacterial and viral infections. Taking immunosuppressive drugs increases the risk of tumors and cancer as well.

Researchers do not fully know what long-term effects this procedure may have. Also, although the early results of the Edmonton protocol are very encouraging, more research is needed to answer questions about how long the islets will survive and how often the transplantation procedure will be successful.

A major obstacle to widespread use of islet transplantation will be the shortage of islet cells. The supply available from deceased donors will be enough for only a small percentage of those with type 1 diabetes. However, researchers are pursuing avenues for alternative sources, such as creating islet cells from other types of cells. New technologies could then be employed to grow islet cells in the laboratory.

For More Information

For information about clinical trials in islet transplantation, see visit www.clinicaltrials.gov

Additional Information on Pancreatic Islet Transplantation:

The National Diabetes Information Clearinghouse collects resource information on diabetes for the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Reference Collection. This database provides titles, abstracts, and availability information for health information and health education resources. The NIDDK Reference Collection is a service of the National Institutes of Health.

To provide you with the most up-to-date resources, information specialists at the clearinghouse created an automatic search of the NIDDK Reference Collection. To obtain this information, you may view the results of the automatic search on Pancreatic Islet Transplantation.

If you wish to perform your own search of the database, you may access and search the NIDDK Reference Collection database online.

 

   

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