Pancreatic Islet Cell Transplantation

by Diane W. Shannon, MD, MPH

Definition

Islet cells are the cells in the pancreas that make insulin. Pancreatic islet cell transplantation is the transfer of islet cells from a donor to another person. The procedure is being studied as a method to treat select patients with chronic uncontrolled type 1 (and some type 2) diabetes.

The Pancreas

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Reasons for Procedure

Pancreatic islet cells are made up of alpha and beta cells. Type 1 diabetes develops when the beta cells in the pancreas are destroyed. They are destroyed by the body's own immune system. Without these cells, the body is unable to make insulin. As a result, people with type 1 diabetes need daily insulin injections.

Transplants are most commonly used for persons with recurrent severe hypoglycemia (low blood sugars) and/or who are also receiving kidney transplants. Newly transplanted islet cells can produce insulin. This allows better daily control of the blood sugars with a lower risk of hypoglycemia. Hypoglycemia occurs when too much insulin is self-injected or when injected insulin to fails to adapt to changes in the body's glucose use. The transplant reduces, or even may eliminate, the need for self-injection.

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Toxicity from immunosuppressive agents
  • Injury to the liver or the pancreas
  • Cholesterol problems
  • Sensitization—Formation of islet cell antibodies that increase the chance of rejection for this or any future transplant. This may occur from a previous transplants, a blood transfusion, or pregnancy.
  • Return of diabetes symptoms that need to be treated with resumption or increased use of self-injected insulin
  • Nausea, vomiting, and abdominal pain
  • Bleeding
  • Infection
  • Blood clots
  • Worsening of kidney function
  • Worsening of high blood pressure

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

What to Expect    TOP

Prior to Procedure

A review board will determine if you will be eligible for a transplant. Once on the transplant list, one may have to wait months or years for a suitable donor.

Your doctor will order blood tests. A physical exam will be done. These tests will assess the extent and severity of diabetic complications. This includes damage to the kidneys.

You and the donor will be carefully screened by blood and serum to optimize a match. The better the match, the less chance for islet rejection.

Anesthesia

Local or general anesthesia may be used. Local anesthesia will numb the area. You will be asleep with general anesthesia.

Description of Procedure

Pancreas transplant surgery is major surgery and requires special expertise in select medical centers. The cells are delicate and may fail even in the best of circumstances.

Before surgery, islet cells are removed from a donor pancreas. Usually, these cells are used within the next 24 hours.

An incision will be made in the abdomen. A small plastic tube will be placed through the incision and into a major blood vessel of the liver. An ultrasound will be used to locate the right position. Islets cells will be injected through the tube. The cells travel through the vein and attach to the liver. When successful, they will begin making insulin.

Immediately After Procedure

Your blood glucose may be normal immediately following transplantation.

Your immune system may attack the transferred cells. To prevent this type of attack, called rejection, you will be given medications to suppress your immune system.

Similar medications to suppress the immune system are usually needed for the rest of the person’s life to prevent rejection.

How Long Will It Take?

Generally several hours

How Much Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay

4-10 days

Post-procedure Care

At the Hospital

  • Follow your doctor's instructions on how to check your blood glucose on a frequent basis.
  • You and your doctor will closely control and monitor blood sugar levels with the a new insulin requirement. The dose of insulin will need to be adjusted after the transplant.

Your doctor may repeat the process several times to transfer more islet cells.

Preventing Infection

During your stay, the hospital staff will take steps to reduce your chance of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chance of infection, such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incision

Call Your Doctor    TOP

After you leave the hospital, contact your doctor if any of the following occurs:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • High or low blood glucose levels

If you think you have an emergency, call for medical help right away.

RESOURCES:

American College of Surgeons
http://www.facs.org
American Diabetes Association
http://www.diabetes.org

CANADIAN RESOURCES:

Canadian Diabetes Association
http://www.diabetes.ca
Canadian Digestive Health Foundation
http://www.cdhf.ca

References:

Bertuzzi F, Marzorati S, et al. Islet cell transplantation. Curr Mol Med. 2006;6:369-74.
Campbell, PM, Senior, PA, et al. High risk of sensitization after failed islet transplantation. Am J Transplant. 2007; 7:2311.
Demartines N, Schiesser M, et al. An evidence-based analysis of simultaneous pancreas-kidney and pancreas transplantation alone. Am J Transplant. 2005;5:2688-97.
Diabetes mellitus type 1. EBSCO DynaMed website. Available at:
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Updated August 9, 2013. Accessed September 3, 2013.
Fiorina P, Secchi A. Pancreatic islet cell transplant for treatment of diabetes. Endocrinol Metab Clin N Am. 2007;36:999-1013.
Hogan A, Pileggi a, Ricordi C. Transplantation: current developments and future directions: the future of clinical islet transplantation as a cure for diabetes. Front Biosci. 2008;13: 1192-205.
Islet transplantation. American Diabetes Association website. Available at:
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Accessed September 3, 2013.
Leitao CB, Cure P, et al. Current challenges in islet transplantation. Curr Diab Rep. 2008;8:324-31.
Roberson RP. Islet transplantation as a treatment for diabetes: a work in progress. N Engl J Med . 2004;350:694-705.
Shapiro AM, Ricordi C, et al. International trial of the Edmonton protocol for islet transplantation. N Engl J Med. 2006; 355:1318.
6/3/2011 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance
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Mills E, Eyawo O, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.e8.
Last reviewed September 2013 by Michael Woods, MD
Last Updated: 01/22/2014