Islet Cell Transplantation for the Treatment of Diabetes
In islet cell transplantation, beta cells are removed from a donor's pancreas and transferred into a person with diabetes. Beta cells are one type of cell found in the islets of the pancreas and produce insulin, which regulates blood sugar levels. Once transplanted, the donor islets begin to make and release insulin.
In every issue of WebMD the Magazine, we ask our experts to answer readers' questions about a wide range of topics. In our July/August 2012 issue, we asked WebMD's diabetes expert, Michael Dansinger, MD, about the link between diabetes and poor sleep.
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What Are the Benefits of Islet Cell Transplantation?
A successful islet cell transplant can significantly improve the quality of life for a person with diabetes.
Once transplanted, the islet cells resume their role of releasing insulin to maintain normal blood sugar levels in response to food, exercise, and other changes in the body.
Successful islet cell transplantation can provide the following benefits:
Restore or improve the body’s ability to regulate blood sugar levels. The need for frequent blood sugar measurements and daily insulin injections can be reduced, and in a minority of patients, eliminated three years after transplantation. Although being free from insulin injections may only last several months or a year, islet cell transplantation reduces episodes of low blood sugar for a longer time.
Improve the quality of life.
Reduce the progression of long-term complications of diabetes, including heart disease, kidney disease, stroke, and nerve and eye damage.
What Are the Risks of Islet Cell Transplantation?
As with all organ and tissue transplants, rejection of the donor cells is the greatest challenge. The immune system serves to protect the body from "invading" substances that do not belong -- bacteria and viruses, for example. Even though the transplanted islet cells are beneficial, the recipient's immune system recognizes it as "foreign" and tries to destroy it. This attack on the donor tissue is called "rejection."
All transplant recipients must take, for the rest of their life, strong drugs to suppress the immune response and prevent rejection. Many of these drugs have serious side effects. The long-term effects of these immunosuppressive or anti-rejection drugs are not yet known, but it is suspected that they may increase the risk of cancer.
How Successful Is Islet Cell Transplantation for Diabetes?
Scientists developed the procedure for transplanting islet cells to treat diabetes in the 1960s. The first transplantation attempts, which began in the 1990s, succeeded only 8% of the time, which was attributed to the fact that anti-rejection drugs available at the time interfered with insulin's effectiveness.
But in 1999, a clinical trial conducted at the University of Alberta in Edmonton, Canada, brought new hope. Using enhanced techniques to collect and prepare the extremely fragile donor islet cells, as well as using improved anti-rejection drugs, the researchers achieved a 100% success rate. All of the patients in their trial were freed from the need for insulin for at least one month.
However, the success of the ''Edmonton Protocol,'' as it was called, was not as successful in later trials, and the number of islet cell transplantations has decreased in more recent years. The Collaborative Islet Transplant Registry reported in 2009 that 70% of adults with Type I diabetes were free of insulin injections at one year, 50% at two years, and 35% at three years.
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