title: Strategic opportunities in clinical islet transplantation.
abstract: More than 471 patients with type 1 diabetes have received islet transplants at 43 institutions worldwide in the past 5 years. High rates of insulin independence have been observed at 1 year in the leading islet transplant centers, and an international multicenter trial has demonstrated reproducible success of the approach. Loss of insulin independence by 5 years in the majority of recipients remains of concern, and immunosuppressant drug side effects necessitate stringent inclusion criteria for islet-alone candidates that have the most severe, unstable glycemic control despite optimal insulin therapy. The advent of new immunosuppressive drugs with superior side-effect profiles (e.g., LEA29Y and FTY720) may open up opportunities for more "islet-friendly" approaches. Future opportunities to expand the donor pool using living donor islet transplantation are within reach, and will be enhanced considerably with both donor and recipient adjunctive treatment using islet-specific growth-factors.
authors.affiliation: Clinical Islet Transplant Program, University of Alberta, Edmonton, Canada. shapiro@islet.ca
authors.forename: A M James
authors.initials: AM
authors.lastname: Shapiro
authors.forename: Jonathan R T
authors.initials: JR
authors.lastname: Lakey
authors.forename: Breay W
authors.initials: BW
authors.lastname: Paty
authors.forename: Peter A
authors.initials: PA
authors.lastname: Senior
authors.forename: David L
authors.initials: DL
authors.lastname: Bigam
authors.forename: Edmond A
authors.initials: EA
authors.lastname: Ryan
mesh_terms: D000818:Animals; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007328:Insulin / Q000378:metabolism; D000078790:Insulin Secretion; D007515:Islets of Langerhans / Q000378:metabolism; D016381:Islets of Langerhans Transplantation / Q000379:methods* / Q000639:trends*; D019520:Living Donors; D011184:Postoperative Period; D016019:Survival Analysis
chemical_list: D007166:Immunosuppressive Agents; D007328:Insulin