Our Summary

This research paper discusses the progress made in pancreatic islet transplantation, a procedure that is gaining popularity as a safe and minimally invasive treatment for type 1 diabetes. Over 1500 patients have been treated since 2000, and it’s becoming a realistic option for certain patients who struggle with issues like severe low blood sugar episodes and fluctuations in blood sugar levels. The paper outlines the process of isolating human islet cells, preparing them for transplant, and performing the transplant itself. It also delves into who would be a good candidate for this procedure, how to optimize the suppression of the patient’s immune system to avoid rejection of the transplanted cells, and how to manage additional treatments to support the immune system and reduce inflammation. It further discusses potential risks, long-term outcomes, and advancements in post-transplant treatment. The ultimate goal is to make this treatment more readily available to type 1 diabetes patients, and perhaps even a potential cure.

FAQs

  1. What is clinical pancreatic islet transplantation and who is it suitable for?
  2. What are the techniques required for human islet isolation and transplantation?
  3. What are the potential risks and long-term outcomes of clinical pancreatic islet transplantation?

Doctor’s Tip

A doctor might tell a patient considering a pancreas transplant to ensure they have a thorough understanding of the procedure, potential risks, and long-term outcomes. They may also advise the patient to follow their post-transplant care plan closely, including taking immunosuppressant medications as prescribed and monitoring for any signs of rejection. It is important for the patient to maintain regular follow-up appointments with their healthcare team to ensure the transplant is successful and their overall health is managed effectively.

Suitable For

Patients who are typically recommended for pancreas transplant include those with type 1 diabetes mellitus who have severe hypoglycaemia unawareness, frequent and severe hypoglycaemic episodes, and unstable blood sugar levels (glycaemic lability). These patients may have difficulty controlling their blood sugar levels with insulin therapy alone and may experience significant complications from their diabetes.

Pancreas transplant may also be recommended for patients who have complications from their diabetes, such as kidney damage (diabetic nephropathy) or nerve damage (diabetic neuropathy), that may be improved with better blood sugar control.

Overall, pancreas transplant is considered for patients with type 1 diabetes who have difficulty managing their blood sugar levels and are experiencing significant complications from their disease. These patients may benefit from the improved blood sugar control and potential for long-term disease management that a pancreas transplant can provide.

Timeline

Before pancreas transplant:

  • Patient is diagnosed with type 1 diabetes mellitus and experiences symptoms such as frequent urination, extreme thirst, unexplained weight loss, and fatigue.
  • Patient undergoes various treatments to manage their diabetes, such as insulin therapy, diet and exercise.
  • Over time, the patient may develop complications of diabetes, such as neuropathy, retinopathy, and kidney disease.
  • Patient is evaluated by a transplant team to determine if they are a candidate for pancreas transplant.

After pancreas transplant:

  • Patient undergoes the pancreas transplant surgery, which involves removing the diseased pancreas and replacing it with a healthy donor pancreas.
  • Patient is monitored closely post-transplant for complications such as rejection, infection, and side effects of immunosuppressive medications.
  • Patient may experience improved blood sugar control, decreased insulin requirements, and reduced risk of complications associated with diabetes.
  • Patient continues to be followed by the transplant team for long-term monitoring and management of their transplant.

What to Ask Your Doctor

  1. What is the success rate of pancreas transplants in patients with my specific medical history and condition?

  2. What are the potential risks and complications associated with pancreas transplant surgery?

  3. How long is the recovery period after a pancreas transplant and what can I expect during the recovery process?

  4. What type of immunosuppressant medications will I need to take after the transplant and what are the potential side effects?

  5. How often will I need to follow-up with my transplant team post-surgery and what ongoing care will be required?

  6. What lifestyle changes will I need to make after a pancreas transplant to ensure the success of the transplant?

  7. How will a pancreas transplant impact my overall quality of life and ability to manage my diabetes long-term?

  8. Are there any alternative treatments or therapies that I should consider before deciding on a pancreas transplant?

  9. What is the long-term outlook for patients who undergo a pancreas transplant in terms of diabetes management and overall health?

  10. Are there any research studies or clinical trials related to pancreas transplants that I should be aware of?

Reference

Authors: Shapiro AM, Pokrywczynska M, Ricordi C. Journal: Nat Rev Endocrinol. 2017 May;13(5):268-277. doi: 10.1038/nrendo.2016.178. Epub 2016 Nov 11. PMID: 27834384