Islet allotransplantation in type 1 diabetic patients.
Islet transplantation was proposed more than 10 years ago as treatment for normalising glucose homeostasis in type 1 diabetic patients. Since the beginning it has aroused great interest among diabetic patients being an easy procedure, burdened by minor complications: islet transplantation in fact consists on a transhepatic percutaneous injection under local anaesthesia. The initial clinical outcomes not came up to expectations, being low the insulin independence rate and the long term graft function in recipients. Recently, thanks to the introduction of new immunosuppression strategies, clinical data greatly improved: insulin independence was reached in all recipients and maintained in more than 70% of them 2 years from the transplant. The need of an immunosuppression therapy limits the indication of islet transplantation to diabetic patients already immunosuppressed for a previous organ transplant or to patients with brittle diabetes, that is not controlled also with the new strategies of insulin treatment, with a poor quality of life and an increased rate of diabetic complications. Other problems are represented by the progressive decrease of graft function during long term follow up, and by the low number of organ donors that limits the number of transplantation feasible per year.
Bertuzzi
F
F
Surgical and Medicine Department, Dibit, Vita-Salute University, S. Raffaele Scientific Institute, Milan, Italy. bertuzzi.federico@hsr.it
Maffi
P
P
Nano
R
R
Aldrighetti
L
L
Clissi
B
B
Melzi
R
R
Antonioli
B
B
Marzorati
S
S
Davalli
A M
AM
Secchi
A
A
Di Carlo
V
V
D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D006801:Humans; D007515:Islets of Langerhans / Q000502:physiology; D016381:Islets of Langerhans Transplantation / Q000502:physiology; D017211:Treatment Failure