Transplanting Just the Islet Cells
Dr. Peters: Those patients must be very happy -- no insulin and doing well. Now let's talk about islet cell transplants. What can you tell me about them?
Dr. Rickels: Islet transplantation is currently being investigated in the United States as a minimally invasive alternative to transplanting a whole organ. Many pancreases, for technical reasons, are not suitable to be transplanted as a whole organ but can be good sources of islet cells that can be isolated and transplanted to several patients with type 1 diabetes. In that sense, it optimizes the use of the donor pancreas. It also extends the procedure for replacing islet cells in patients with type 1 diabetes who might not be candidates to receive a whole pancreas transplant.
We are currently investigating islet transplantation for patients who have already received a kidney transplant and so are already committed to immunosuppression, as well as for patients with type 1 diabetes who are experiencing severe problems from hypoglycemia.[1,2] Both of those groups can already receive a pancreas transplant either after their kidney transplant or alone as treatment for severe hypoglycemia, but because of the major surgical risks, we feel that those groups would benefit in the future from having the potential for islet transplantation.
Dr. Peters: How do you give islet cells?
Dr. Rickels: Islet cells are injected into the portal vein, which is the main blood vessel draining the intestines to the liver. Access to the portal vein can be obtained surgically, in which case the surgeon performs a mini-laparotomy to access the mesenteric vein leading to the portal vein. Access can also be obtained percutaneously by an interventional radiologist who passes a needle through the liver and gains access to the portal vein in a minimally invasive procedure performed under local anesthesia.
Once the catheter is placed in the portal vein, the purified islet cells -- they come in a bag much like blood products -- are infused into the portal vein, from where they follow the blood flow through the liver and end up lodging within the sinusoids, dispersed throughout the liver.
Medscape Diabetes © 2013
Cite this: Transplant Options for Patients With Type 1 Diabetes - Medscape - Jun 28, 2013.