Islet Cell Transplantation

This article, derived from a meeting on advances in transplantation but incorporating new data, focuses on the aspect that was discussed in detail by Professor James Shapiro, of the University of Alberta, Canada. Diabetes mellitus (DM) is increasing worldwide1 and now affects up to 5% of the population in the UK. Roughly 10% of these patients have type I DM, caused by insulin deficiency secondary to autoimmune destruction of pancreatic islet cells. DM is associated with life-threatening metabolic or vascular complications in 30% of patients2. According to data from the UK Renal Registry, 20% of all new patients in the UK under the age of 65 years requiring dialysis treatment have end-stage renal failure secondary to DM. In addition to renal care, patients with diabetes require a diverse range of services including cardiology and cardiac surgery, vascular surgery and ophthalmology. The Diabetes Control and Complications Trial (DCCT)3 showed that tight glycaemic control delays and reduces diabetic complications. However, intensive insulin treatment is poorly tolerated by many patients and will decrease the number of patients who develop microvascular complications by no more than 30-40%. Further, a small but substantial number of patients have life-threatening hypoglycaemic episodes despite scrupulous attention to their insulin regimens. Therefore, to improve diabetic care, the need is for treatments that achieve metabolic stability and prevent microvascular complications. Reports from Professor Shapiro's team describe major improvements in the early clinical outcome of patients with type I DM treated with human islet cell transplantation by newly developed protocols. Here we discuss the key areas they report that contribute to improvements in the outcome of islet cell transplantation, particularly the use of novel immuno-suppressive strategies.