Short Communication: Pig islet xenotransplantation acceptance in a Latin-American diabetic population

Abstract

Progress in porcine islet xenotransplantation has been accompanied by studies on acceptance of this new procedure by patients, health professionals or the general public. Such studies have not been done in the Latin-American population. We conducted a questionnaire in 108 diabetes patients (insulin-dependent, n = 53; insulin-independent, n = 55) in a public hospital in Argentina. The questions addressed the general perception of the xenotransplant procedure and specific items related to the outcome (achieving insulin independence, improvement in metabolic control, delay in emergence of diabetic complications, need for repeat procedures, potential of transfer of infectious viruses, association with psychological problems, and anticipated success in relation to achieving a cure). Eighty-six (79%) of the patients accepted islet xenotransplantation; this incidence was not different for insulin-dependent or insulin-independent patients, patients with or without complications, or patients with good or poor metabolic control. Also, over 75% of patients accepted the procedure if this is only associated with a reduction in insulin requirement, if the procedure just delays but not prevents the onset of complications, or if the procedure needs to be performed every 6 months. Fifty-seven percent of patients indicated acceptance even if the potential transmission of a virus infection cannot be completely ruled out: this outcome was not affected by the outbreak of the H1N1 flu epidemic during the conduct of this study. Forty percent of patients indicated that living with porcine cells in their body could give psychological problems. We conclude that this population of Latin-American diabetic patients shows a high acceptance rate of a porcine islet xenotransplantation product.

Porcine Islet Xenotransplantation for the Treatment of Type 1 Diabetes

“…Seventy-five percent indicated they would accept the porcine tissue even if it only reduced their insulin requirements, temporarily prevented the progression of secondary complications, or needed to be repeated every six months. Interestingly, 40% indicated that they believe living with porcine cells could cause them psychological distress (Abalovich et al, 2010). This is in contrast to a French study from 5 years previous, where it was found that the proportion of individuals with type 1 diabetes willing to accept a transplant was much lower.…”

Level of acceptance of islet cell and kidney xenotransplants by personnel of hospitals with and without experience in clinical xenotransplantation

“…Therefore, the findings of the comparative analysis of the attitude of the personal in the Hospital Eva Perón workers that were not in- In numerous studies, the acceptance of xenotransplantation in different human communities has been studied in recent years. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] This acceptance depends on knowledge on efficacy and safety and is-as mentioned by Carl Groth-related to fear of the unknown, what he called "fear factor." 30 However, it is difficult to establish the weight of this factor as a barrier to apply this treatment.…”

“…In numerous studies, the acceptance of xenotransplantation in different human communities has been studied in recent years . This acceptance depends on knowledge on efficacy and safety and is—as mentioned by Carl Groth—related to fear of the unknown, what he called “fear factor.” However, it is difficult to establish the weight of this factor as a barrier to apply this treatment.…”

“…Meanwhile, numerous studies evaluated the willingness to accept the xenotransplantation by patients and general public. [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] For example, a survey of a population of diabetic patients from a public hospital in Argentina in 2010 showed a high degree of acceptance (79%). 11 It was observed that the degree of approbation was related to difficulties in managing a disease like diabetes, and was also in the context of limited financial resources.…”

What would surgeons like from materials scientists?

“…While some have raised concerns regarding zoonotic infections, it appears that the risk of infectious transmission is lower than that observed in human islets . Porcine islet transplantation would appear to be cost effective compared to standard management, is generally morally acceptable to most diabetic patients, and regulatory issues appear soluble . There are, however, formidable immunologic barriers which must be circumvented to permit successful engraftment in humans.…”