Clinical pancreatic islet transplantation.
Clinical pancreatic islet transplantation can be considered one of the safest and least invasive transplant procedures. Remarkable progress has occurred in both the technical aspects of islet cell processing and the outcomes of clinical islet transplantation. With >1,500 patients treated since 2000, this therapeutic strategy has moved from a curiosity to a realistic treatment option for selected patients with type 1 diabetes mellitus (that is, those with hypoglycaemia unawareness, severe hypoglycaemic episodes and glycaemic lability). This Review outlines the techniques required for human islet isolation, in vitro culture before the transplant and clinical islet transplantation, and discusses indications, optimization of recipient immunosuppression and management of adjunctive immunomodulatory and anti-inflammatory strategies. The potential risks, long-term outcomes and advances in treatment after the transplant are also discussed to further move this treatment towards becoming a more widely available option for patients with type 1 diabetes mellitus and eventually a potential cure.
Clinical Islet Transplant Program, University of Alberta, 2000 College Plaza, 8215 112th Street, Edmonton, Alberta T6G 2C8, Canada.|The Diabetes Research Institute Federation, 1450 NW 10 Avenue, Miami, Florida 33136, USA.|The Cure Alliance, 550 Bay Point Road, Miami, Florida 33137, USA.
A M James
AM
Shapiro
The Diabetes Research Institute Federation, 1450 NW 10 Avenue, Miami, Florida 33136, USA.|The Cure Alliance, 550 Bay Point Road, Miami, Florida 33137, USA.|Department of Regenerative Medicine, Nicolaus Copernicus University in Torun, Ludwik Rydygier Medical College in Bydgoszcz, Karlowicza 24 Street, 85-092 Bydgoszcz, Poland.
Marta
M
Pokrywczynska
The Diabetes Research Institute Federation, 1450 NW 10 Avenue, Miami, Florida 33136, USA.|The Cure Alliance, 550 Bay Point Road, Miami, Florida 33137, USA.|Diabetes Research Institute and Cell Transplant Program, University of Miami Miller School of Medicine, 1450 NW 10th Avenue, Miami, Florida 33136, USA.
Camillo
C
Ricordi
D000818:Animals; D017326:Clinical Trials, Phase III as Topic / Q000379:methods; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000378:metabolism* / Q000628:therapy*; D006801:Humans; D007515:Islets of Langerhans / Q000378:metabolism; D016381:Islets of Langerhans Transplantation / Q000009:adverse effects / Q000379:methods*; D015337:Multicenter Studies as Topic / Q000379:methods; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods