Technical aspects of islet preparation and transplantation

Abstract

The introduction of insulin therapy for the management of diabetes mellitus is arguably the greatest milestone in the history of modern medicine. P-cell replacement therapy is the only treatment that reestablishes and maintains longterm physiological normoglycemia. Until recently, successful clinical outcomes of pancreas transplantation for patients with long-standing diabetes were much superior to that of islet transplantation. Significant advances in islet isolation and purification technology, the development of more specific and less diabetogenic immunosuppressants and the prophylactic administration of antiviral agents have rekindled a worldwide interest in islet transplantation. This chapter will review the rationale of islet transplantation and the development of islet isolation and purification. The challenges facing clinical islet transplantation in the twenty-first century will also be introduced.

Causes of limited survival of microencapsulated pancreatic islet grafts

“…Even without deleterious immunosuppressive protocols, only 0.1% of the type 1 diabetic population could be transplanted with the currently limited supply of donor organs [8]. The use of donor organs is especially inefficient with islet transplantation, since successful islet transplantation requires multiple (two to four) donors per recipient [9]. It can therefore be argued that islet transplantation cannot become a standard treatment modality for people with type 1 diabetes until graft acceptance can be established without deleterious side effects for the recipient and until a plentiful source of islets can be identified.…”

Efficacy of Human Islet Isolation From the Tail Section of the Pancreas for the Possibility of Living Donor Islet Transplantation

“…Purification of a large amount of tissue is difficult even using COBE 2991 cell processor (7). In this study, purity of islets in the whole pancreas group was significantly lower compared with the other two groups.…”

“…Recently, the University of Minnesota demonstrated that an islet transplantation from a single donor high quality pancreas could cure a patient with type 1 diabetes (5). It is apparent that obtaining high quality isolated islets from high quality pancreata is extremely important to achieve successful clinical islet transplantations (6,7).…”

Autoimmune diabetic patients undergoing allogeneic islet transplantation: are we ready for a regulatory T-cell therapy?

“…The ideal donor selection and the difficulties in islet preparation are key components for islet transplant success but this goes behind the scope of this review and has been properly reviewed elsewhere [79].…”