title: Beta-cell replacement therapy: current outcomes and future landscape.
abstract: OBJECTIVE
  This article provides a summary of the current outcomes of β-cell replacement strategies, an algorithm for choosing a specific modality while highlighting associated advantages and disadvantages, and outlines remaining challenges and areas of active investigation in β-cell replacement therapy.
  
  
  RESULTS
  The most recent reports of islet cell allotransplantation have shown improvements over previous eras and now rival some outcomes of pancreas alone transplantation. Active areas of investigation are focused on improving techniques for islet isolation, graft monitoring, and managing challenges posed by the innate and alloimmune systems.
  
  
  CONCLUSIONS
  Patients with insulin-dependent diabetes who continue to experience life threatening hypoglycemia despite maximal medical management can benefit from β-cell replacement. Emerging nontransplant technologies have not provided a physiologic euglycemic state to the extent offered by transplantation. Islet transplantation eliminates hypoglycemic episodes/unawareness, facilitates normalization of hemoglobin A1c (HbA1c), decreases microvascular disease progression, and improves quality of life for patients with problematic diabetes. Mid- and long-term outcomes of islet transplantation performed at expert centers approximate those of registry reports of solitary pancreas transplant, whereas the complication profile is quite favorable.
authors.affiliation: aDepartment of Surgery bDepartment of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA.
authors.forename: Ty B
authors.initials: TB
authors.lastname: Dunn
authors.forename: Varvara
authors.initials: V
authors.lastname: Kirchner
authors.forename: Melena D
authors.initials: MD
authors.lastname: Bellin
mesh_terms: D000818:Animals; D064987:Cell- and Tissue-Based Therapy; D006801:Humans; D050417:Insulin-Secreting Cells; D016381:Islets of Langerhans Transplantation / Q000379:methods; D011788:Quality of Life; D016896:Treatment Outcome