Article title: Pancreatic Islet Transplantation: NIDDK
Conditions: diabetes, pancreas, Type 1 diabetes
Source: NIDDK
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 beta cells are destroyed by the body's immune system.
Islet Transplantation
In pancreatic islet transplantation, cells are taken from a donor pancreas and transferred into another person. Once implanted, the new 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.
New Research Developments
Scientists have made many advances in islet transplantation over the past 25 years. Dr. James Shapiro and colleagues at the University of Alberta in Edmonton, Canada, have used a new procedure called the Edmonton Protocol to treat eight patients with type 1 diabetes. These patients have been completely freed from insulin injections since the first transplant in mid-1999.
On July 13, 2000, the National Institutes of Health (NIH) and the Juvenile Diabetes Research Foundation International announced that they would fund a clinical trial to test Dr. Shapiro's promising new technique for transplanting islet cells into the large vein in the liver. The trial will test the procedure in 40 people around the world. The NIH-funded Immune Tolerance Network (ITN) is leading the 7-year study and will be in charge of recruiting patients. To be considered for the trial, people must meet the following criteria:
The Edmonton Protocol
Researchers use specialized enzymes to remove islets from the pancreas of a deceased donor. For an average-size person (70 kg), a typical transplant requires about 1 million islets, equal to two donor organs. Because the islets are extremely fragile, transplantation occurs immediately after they are removed.
The transplant itself is easy and takes less than an hour to complete. 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.
It takes some 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.
Benefits and Risks of Transplantation
The goal of islet transplantation is to infuse enough islets to control the blood glucose level without injections. 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 drugs that stop the immune system from rejecting the transplanted islets. A physician can explain the potential risks of these drugs.
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 or antirejection drugs are needed to keep the transplanted islets functioning.
Researchers do not fully know what long-term effects these drugs 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.
Antirejection Drugs
The Edmonton Protocol uses a combination of antirejection drugs that include 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.
For More Information
To obtain more information on islet transplantation or for patient enrollment in the clinical trial, please contact the following organization:
Immune Tolerance Network (ITN)
Patient Information
5743 South
Drexel Avenue, Suite 200
Chicago, IL 60637
Phone: (773) 834-5341
(United States)
or (780) 407-1501 (Canada)
Email: islet-info@immunetolerance.org
Internet:
http://www.immunetolerance.org/
The National Diabetes Information Clearinghouse collects resource information on diabetes for the Combined Health Information Database (CHID), which is produced by health-related agencies of the Federal Government. This database provides titles, abstracts, and availability information for health information and health education resources.
To provide you with the most up-to-date resources, information specialists at the clearinghouse created an automatic search of CHID. To obtain this information, you may view the results of the automatic search on Pancreatic Islet Transplantation.
Or, if you wish to perform your own search of the database, you may access the CHID Online web site and search CHID yourself.
1 Information Way
Bethesda, MD 20892-3560
Email: http://www.niddk.nih.gov/tools/mail_ndic.htm
The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1978, the clearinghouse provides information about diabetes to people with diabetes and their families, health care professionals, and the public. NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.
Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.
This e-text is not copyrighted. The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired.
What do you think about the features of this website? Take our user survey and have your say:
Tools & Services:
Medical Articles:
Search Specialists by State and City
By using this site you agree to our Terms of Use. Information provided on this site is for informational purposes only; it is not intended as a substitute for advice from your own medical team. The information on this site is not to be used for diagnosing or treating any health concerns you may have - please contact your physician or health care professional for all your medical needs. Please see our Terms of Use.
Copyright © 2009 Health Grades Inc. All rights reserved.
