Transplantation of Pancreatic Islets

This chapter reviews the current status of human islet allotransplantation in type 1 diabetes and islet autotransplantation in severe chronic pancreatitis before briefly discussing research priorities in these fields. Islet allotransplantation is an effective and minimally invasive treatment modality for patients with type 1 diabetes and impaired awareness of hypoglycemia in whom current behavioral, pharmacologic, and technological interventions have failed to prevent life-threatening severe hypoglycemic episodes. Islet transplantation restores near-normoglycemia, awareness of hypoglycemia, and protection from severe hypoglycemia in this patient population. Islet transplantation is reimbursed for this indication in several countries while transitioning to an approved therapy in other countries. Islet allotransplantation is also used in patients with type 1 diabetes and end-stage renal failure who cannot meet clinically appropriate glycemic goals and/or in whom episodes of severe hypoglycemia persist. Patients willing to consider islet allotransplantation must accept the risks associated with chronic immunosuppression. For islet allotransplantation to become more firmly established in diabetes care, further improvements in the efficiency of islet processing, durability of transplant function, and safety of immunosuppression are required. Total pancreatectomy with islet autotransplantation has become an accepted treatment modality for severe, chronic pancreatitis refractory to medical and endoscopic therapies. Total pancreatectomy can ameliorate pain and improve quality of life and islet autotransplantation preserves meaningful islet function in most patients.