Islet cell transplantation today.
BACKGROUND
Long-term studies strongly suggest that tight control of blood glucose can prevent the development and retard the progression of chronic complications of type 1 diabetes mellitus. In contrast to conventional insulin treatment, replacement of a patient's islets of Langerhans either by pancreas organ transplantation or by isolated islet transplantation is the only treatment to achieve a constant normoglycemic state and avoiding hypoglycemic episodes, a typical adverse event of multiple daily insulin injections. However, the cost of this benefit is still the need for immunosuppressive treatment of the recipient with all its potential risks.


METHODS
Islet cell transplantation offers the advantage of being performed as a minimally invasive procedure in which islets can be perfused percutaneously into the liver via the portal vein. Between January 1990 and December 2004, 458 pancreatic islet transplants worldwide have been reported to the International Islet Transplant Registry (ITR) at our Third Medical Department, University of Giessen/Germany.


RESULTS
Data analysis of islet cell transplants performed in the last 5 years (1999-2004) shows at 1 year after adult islet transplantation a patient survival rate of 97%, a functioning islet graft in 82% of the cases, whereas insulin independence was meanwhile achieved in 43% of the cases. However, using a novel protocol established by the Edmonton Center/Canada, the insulin independence rates have improved significantly reaching meanwhile a 50-80% level.


CONCLUSIONS
Finally, the concept of islet cell or stem cell transplantation is most attractive, as it offers many perspectives: islet cell availability could become unlimited and islet or stem cells my be transplanted without life-long immunosuppressive treatment of the recipient, just to mention two of them.
Bretzel
Reinhard G
RG
Third Medical Department and Policlinic, University Hospital Giessen and Marburg GmbH, Rodthohl 6, 35392 Giessen, Germany. reinhard.bretzel@uniklinikum-giessen.de
Jahr
Henning
H
Eckhard
Michael
M
Martin
Isabel
I
Winter
Daniel
D
Brendel
Mathias D
MD
D000818:Animals; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000601:surgery*; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D007003:Hypoglycemia / Q000517:prevention & control; D016381:Islets of Langerhans Transplantation / Q000266:history / Q000379:methods / Q000639:trends; D010043:Outcome and Process Assessment, Health Care; D013552:Swine; D023001:Transplantation Tolerance / Q000276:immunology