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Islet Transplantation for Patients with Diabetes

Although islet transplantation has been performed in diabetics for several decades, the procedure has been successful in fewer than 10 percent of patients. Among the many reasons postulated for this poor track record is that immunosuppressive regimens generally include glucocorticoids, which induce insulin resistance. This report from researchers at the University of Alberta describes islet transplantation achieved by infusion of cadaveric donor islets into the portal veins of 7 consecutive type 1 diabetic patients. All were treated with a glucocorticoid-free immunosuppressive regimen consisting of sirolimus, tacrolimus, and daclizumab (a monoclonal antibody against the interleukin-2 receptor).

At the time of the most recent follow-up (median, 1 year), none of the patients required exogenous insulin. Six of the patients underwent a second islet infusion, and 1 patient required 3 transplants to become insulin independent. There have been no episodes of acute rejection. At 6 months, all patients had glycosylated hemoglobin levels below 6 percent and fasting serum glucose levels below 120 mg/dL.

Comment: Although longer-term follow-up is necessary, these results are encouraging. An editorialist attributes the impressive outcome to both the use of high-quality islets and the innovative immunosuppressive regimen. An obvious caveat is the need for more than 1 transplant in all of these patients.

— AS Brett

Published in Journal Watch General Medicine August 11, 2000

Citation(s):

Shapiro AMJ et al. Islet transplantation in seven patients with type 1 diabetes mellitus using a glucocorticoid-free immunosuppressive regimen. N Engl J Med 2000 Jul 27 343 230-238.

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Robertson RP. Successful islet transplantation for patients with diabetes -- Fact or fantasy? N Engl J Med 2000 Jul 27 343 289-290.

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