title: [Islet transplantation for treatment of type-1 diabetes mellitus].
abstract: BACKGROUND
  Organ pancreas transplantation represents the only method enabling long-term normalization of glucose metabolism in type-1 diabetic subjects so far. Unfortunately, surgical complications of this kind of therapy are still frequent. As a safer alternative, transplantation of isolated pancreatic islets was introduced at the Institute for Clinical and Experimental Medicine as a clinical experiment in the year 2005.
  
  
  RESULTS
  We isolated the islets from pancreases of cadaveric donors which did not fulfil criteria to perform organ pancreas transplantation. Altogether, 36 islet implantations were performed in 28 C-peptide negative subjects suffering from type-1 diabetes by August 2010. In 15 subjects (21 implantations) the main indication was extremely instable course of diabetes due to the hypoglycaemia unawareness syndrome. In 5 and 3 cases, combined islet and kidney and islet and liver transplants were performed, respectively. In addition, islet autotransplantation was performed in 5 subjects undergoing total pancreatectomy. No patient died during the study period. In all but 1 patient with primary islet afunction, islet transplantation led to a complete cure of the hypoglycemia unawareness syndrome. Out of 15 patients, 11 subjects in this group showed a significant C-peptide production (> 0.2 pmol/ml) after 1 year. The mean insulin dose after allotransplantation decreased from 37 to 14 units per day and in 3 subjects, insulin therapy could be withdrawn. Serious technical complications occurred in 6 subjects, which only in 2 cases required surgical revision and did not cause long-term sequels.
  
  
  CONCLUSIONS
  In comparison with organ pancreas transplantation, pancreatic islet transplantation represents a substantially safer method for restitution of endogenous insulin production. Though it eliminates serious hypoglycemic episodes in labile diabetes, complete insulin withdrawal is still often not possible. However, due to continuing progress in the laboratory techniques as well as in the transplant procedure itself, the results are steadily improving.
authors.affiliation: Institut klinické a experimentální medicíny Praha, Klinika diabetologie, Centrum diabetologie. frsa@medicon.cz
authors.forename: Frantisek
authors.initials: F
authors.lastname: Saudek
authors.forename: Peter
authors.initials: P
authors.lastname: Girman
authors.forename: Jan
authors.initials: J
authors.lastname: Kríz
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Berková
authors.forename: Klára
authors.initials: K
authors.lastname: Zacharovová
authors.forename: Tomás
authors.initials: T
authors.lastname: Koblas
authors.forename: Lenka
authors.initials: L
authors.lastname: Pektorová
authors.forename: Ema
authors.initials: E
authors.lastname: Vávrová
authors.forename: Martina
authors.initials: M
authors.lastname: Mindlová
authors.forename: David
authors.initials: D
authors.lastname: Habart
authors.forename: Jan
authors.initials: J
authors.lastname: Peregrin
authors.forename: Kvetoslav
authors.initials: K
authors.lastname: Lipár
authors.forename: Martin
authors.initials: M
authors.lastname: Oliverius
authors.forename: Eva
authors.initials: E
authors.lastname: Dovolilová
authors.forename: Evzena
authors.initials: E
authors.lastname: Cíhalová
authors.forename: Vít
authors.initials: V
authors.lastname: Bobek
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D008297:Male; D008875:Middle Aged
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin