Pancreatic Islet Cell Transplantation Overview

Islet cells are the cells in the pancreas that make insulin. Pancreatic islet cell transplantation is the transfer of islet cells from a donor to another person. The procedure is being studied as a method to treat chronic pancreatitis or type 1 diabetes .

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Prior to Procedure

Your doctor will order blood tests. A physical exam will be done. These tests will assess the extent and severity of diabetic complications. This includes damage to the kidneys. The donor must also be carefully screened for blood and serum matching.

Anesthesia

Local or general anesthesia may be used. Local will numb the area. You will be asleep with general anesthesia.

Description of Procedure

Before surgery, islet cells are removed from one or more donor pancreases. Usually, these cells are used within the next 24 hours.

A small incision will be made in the abdomen. A catheter (small plastic tube) will be placed through the incision and into a major blood vessel of the liver. An ultrasound will be used to locate the right position. Islets cells will be injected through the catheter. The cells travel through the vein and attach to the liver. There, they will begin making insulin.

Immediately After Procedure

It is important to maintain a normal blood glucose level. A high blood glucose could damage the new islet cells. Insulin will be given through an IV for the first several days. This will help keep your blood glucose levels down.

Your immune system will attack the transferred cells. To prevent this type of attack, called early acute rejection, you will be given medicines to suppress your immune system.

Similar medicines to suppress the immune system are usually needed for the rest of the person’s life to prevent rejection.

How Long Will It Take?

About one hour

How Much Will It Hurt?

The injection of local anesthetic may sting or burn. Anesthesia will prevent pain during the procedure. After the procedure, some patients experience pain or soreness for a few days. If you have discomfort, ask your doctor about pain medicine.

Average Hospital Stay

3-4 days

Post-procedure Care

• Keep the incision wound clean.

• Follow your doctor’s instructions about wound care.

• Check your blood glucose frequently. Follow your doctor’s instructions.

• Closely control blood sugar levels with insulin.

Your doctor may repeat the process several times to transfer more islet cells.

RESOURCES:

American College of Surgeons
http://www.facs.org/

American Diabetes Association
http://www.diabetes.org/

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca/

Canadian Digestive Health Foundation
http://www.cdhf.ca/aboutcdhf.htm/

References:

Bertuzzi F, Marzorati S, Secchi A. Islet cell transplantation. Curr Mol Med. 2006;6:369-74.

Campbell, PM, Senior, PA, Salam, A, et al. High risk of sensitization after failed islet transplantation. Am J Transplant.2007; 7:2311.

Demartines N, Schiesser M, Clavien PA. An evidence-based analysis of simultaneous pancreas-kidney and pancreas transplantation alone. Am J Transplant. 2005;5:2688-97.

Fiorina P, Secchi A: Pancreatic Islet Cell Transplant for Treatment of Diabetes. Endocrinol Metab Clin N Am. 2007;36:999-1013.

Hogan A, Pileggi a, Ricordi C: Transplantation: current developments and future directions: the future of clinical islet transplantation as a cure for diabetes. Front Biosci. 2008;13: 1192-205.

Islet cell transplant program for type 1 diabetes successful across international centers. American Diabetes Association website. Available at: http://www.diabetes.org/for-media/2004-press-releases/edmonton.jsp . Accessed September 16, 2005.

Islet transplantation. American Diabetes Association website. Available at: http://www.diabetes.org/utils/printthispage.jsp?PageID=TYPE1DIABETES3_232955 . Accessed September 16, 2005.

Leitao CB, Cure P, Theravanij T, et al: Current challenges in islet transplantation. Curr Diab Rep. 2008;8:324-31.

Roberson RP. Islet transplantation as a treatment for diabetes: a work in progress. N Engl J Med. 2004;350:694-705.

Shapiro, AM, Ricordi, C, Hering, BJ, et al. International trial of the Edmonton protocol for islet transplantation. N Engl J Med. 2006; 355:1318.

Townsend CM, Beauchamp RD, Evers BM, et al., eds. Transplantation of abdominal organs. Sabiston Textbook of Surgery. 17th ed. Philadelphia, PA: Elsevier; 2004.