Islet Cell Transplants

There has been a huge interest of late in islet cell transplants.  Indeed, an immense amount of press has been generated since researchers in Edmonton, Alberta started transplanting islet cells (harvested from cadavers) into individuals with type 1 diabetes.  Although the procedure is innovative and exciting and, importantly, most recipients have fewer episodes of problematic hypoglycemia, there are, I'm sorry to say, some very big 'buts:'
  • Islet cell transplants have been performed in very few people; hence, experience with this procedure remains limited.
  • Almost all islet cell transplant recipients end up back on insulin.
  • All transplant recipients have to stay on anti-rejection drugs or they will reject the transplanted cells.
  • Certain complications may and indeed, do occur from both the transplant procedure and the anti-rejection drugs including:
    • Blood clots ("partial thrombosis of the portal vein")
    • Bleeding (to the point, on occasion, of requiring a blood transfusion)
    • Mouth ulcers (in almost every single person)
    • Nausea (in half of recipients)
    • Headaches (in about half of recipients)
    • Swollen ankles
    • Reduced numbers of white blood cells (which in theory could make one more prone to infections)
    • Worsening of hypertension (high blood pressure)
    • Worsening of dyslipidemia (abnormal cholesterol and triglycerides)
  • Theoretically, one could receive an islet cell transplant, reject it and then be less able to succeed with a future transplant (when the technique has been 'perfected') because of a build-up of antibodies to islet cells.
I think things were said best by the pioneering Edmonton researchers themselves when, in the medical jounal Lancet, they wrote: "The procedure can...only be justified in patients at great risk from...severe recurrent coma or metabolic instability despite compliance with an optimum insulin regimen."

So, islet cell transplation is not a cure.  But it is a very favourable step forward and hopefully as the technique improves it will become an increasingly effective, safe and useful treatment. 

The ultimate goal, of course, is to have an unlimited supply of islet cells available for transplant and for these cells to be immunologically neutral (which is to say; not being subject to rejection by the recipient).

More information on islet cell transplantation is available at the University of Alberta islet cell transplant web site.