[Therapy of diabetes mellitus. Pancreas transplantation, islet transplantation, stem cell and gene therapy].
The long-term normalization of glucose metabolism - a prerequisite for the prevention of secondary complications in patients with diabetes mellitus - is only possible by transplantation of a whole pancreas or a reasonable number of islets. An absolute indication for pancreas grafting is given in type 1 diabetic patients with end-stage renal disease. The 1-year survival after simultaneous kidney/pancreas transplantation is, according to the international registry, 94-100% for patients, 89-92% for kidneys and 85-87% for the pancreas. The high success rate with long lasting normalization of glucose metabolism leads to a stabilization and/or amelioration of secondary complications, to an increase in quality of life and, most importantly, to a significant reduction in mortality when compared to diabetic kidney recipients. The indications for islet transplantation are similar to those for pancreatic grafting. Islet grafting is only a minor surgical procedure, but islet isolation is difficult. The 1-year survival for the recipients is 98%, for the islets 82% and for insulin-independency 42%. There is a significant decline of islet function to 10% 5 years after transplantation. Stem cell therapy would provide a definitive treatment solution not only for patients with type 1 diabetes. So far, this therapeutic option is still at an early stage of development.
Dieterle
C
C
Diabeteszentrum, Medizinische Klinik Innenstadt, Universität München.
Brendel
M D
MD
Seissler
J
J
Eckhard
M
M
Bretzel
R G
RG
Landgraf
R
R
D003131:Combined Modality Therapy; D003920:Diabetes Mellitus / Q000401:mortality / Q000628:therapy*; D015316:Genetic Therapy / Q000379:methods*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016381:Islets of Langerhans Transplantation / Q000379:methods*; D016030:Kidney Transplantation / Q000379:methods; D016035:Pancreas Transplantation / Q000379:methods*; D012042:Registries; D033581:Stem Cell Transplantation / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome