Nutrition in Clinical Practice

 

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Nutrition in Clinical Practice, Vol. 22, No. 5, 485-493 (2007)
DOI: 10.1177/0115426507022005485

Invited Review

Pancreatic Islet Cell Transplantation: Update and New Developments

Nicholas Onaca, MD*, Bashoo Naziruddin, PhD*, Shinichi Matsumoto, MD, PhD{dagger}, Hirofumi Noguchi, MD, PhD{dagger}, Goran B. Klintmalm, MD, PhD* and Marlon F. Levy, MD{dagger}

* Transplant Services, Baylor Regional Transplant Institute, Baylor University Medical Center, Dallas, Texas; and{dagger} Baylor All Saints Medical Center, Fort Worth, Texas

Correspondence: Nicholas Onaca, MD, Baylor Regional Transplant Institute, 3500 Gaston Avenue, 4 Roberts, Dallas, TX 75246. Electronic mail may be sent to nicholao{at}baylorhealth.edu.

Pancreatic islet cell transplantation is a treatment alternative for patients with type 1 diabetes who experience hypoglycemic unawareness despite maximal care. The good results obtained by the group from Edmonton and other centers, with 80% insulin independence at 1 year posttransplant, are not sustainable over time, with 5-year insulin independence achieved in only 10% of patients. However, persistent graft function, even without insulin independence, results in improved glucose control and avoidance of hypoglycemic events. Changes in organ preservation, islet processing technique, and immunosuppression regimens can result in improvement of results in the future. Islet autotransplantation is an option for patients who undergo total pancreatectomy for chronic pancreatitis with debilitating pain, in which reinfusion of the islets from the resected pancreas can result in avoidance of postsurgical diabetes or enhanced glucose control.


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