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    Live-Donor Transplant May Treat Diabetes

    Woman Donates Half of Pancreas to Aid Daughter With Type 1 Diabetes

    continued...

    Before the surgery, she had frequent, severe low blood sugar episodes that often led to comas. In the weeks following the islet infusion, her blood sugar control stabilized, and Shapiro says she is being weaned off injected insulin.

    American Diabetes Association spokesman Eugene Barrett, MD, PhD, says islet cell transplants offer promise for a select group of people with type 1 diabetes, but he adds they remain an experimental procedure.

    "We don't really know what the long-term outcome will be for these patients," he says.

    Shapiro and colleagues at the University of Alberta in Edmonton, Canada, have performed just over 70 islet cell transplants using cadaver donors. They report that 80% of their patients remained insulin independent, meaning they didn't need injections, after a year. Half of their patients remained insulin independent after three years, but just 10% to 20% were producing enough of their own insulin to avoid injections five years later.

    It won't be known for some time if live-donor islet cell transplants produce better long-term outcomes. And Shapiro acknowledges that questions remain about the safety of the procedure for the donor. One fear has been that if too much of the pancreas is removed the donor could also become diabetic.

    Barrett says the experience from a French research team is reassuring. For several years the researchers have been doing a similar procedure, only instead of transplanting islet cells from the pancreas they have been transplanting a portion of the pancreas itself from live donors to diabetes patients.

    "The donors are not entirely normal in terms of pancreatic function, but they seem to do pretty well," he says. "The fear that they would develop diabetes isn't being borne out."

    Shapiro says there are plans to do more live-donor islet cell transplants in both Japan and at his institution in Edmonton.

    "We are moving forward cautiously, but I am optimistic that this could supplement or even replace cadaveric transplants," he says. "There are clearly not enough organ donors to go around, and the living donor procedure could fulfill a clear niche. But, obviously, curing diabetes in one person at the expense of creating it in another would be an unacceptable and catastrophic outcome."

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