Anne L. Peters, MD, CDE; Michael R. Rickels, MD

Disclosures

June 28, 2013

In This Article

Dealing With Rejection

Dr. Peters: Rejection of islet cells is a big issue. How do you protect them, and what kind of immunosuppression is used? How can you make an islet cell last longer?

Dr. Rickels: The immunosuppression is very similar to what is used for whole organ transplantation. One important difference with islet transplant is that until they have a new blood supply (which can take weeks up to a few months to establish robustly), glucocorticoids, which are commonly used in transplantation, have a very detrimental effect on the survival of the transplanted islets. So, steroids are not used, but instead we use agents such as T-cell-depleting agents that are used for solid organ transplantation.

The maintenance of immunosuppression is achieved with drugs such as calcineurin inhibitors and mTOR inhibitors, which protect the islet cells in the long term. The important feature for transplantation of the whole pancreas or islet cells in type 1 diabetes is that because it's an autoimmune disease, we worry not just about rejection of the pancreas or the islets, but recurrent autoimmune diabetes affecting the pancreas islet transplant. In most instances, the immunosuppression that we select for preventing the alloimmune response helps to protect the individual from recurrent autoimmunity affecting their transplant.

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