Pancreatic Islet Cell Transplantation
by
Diane W. Shannon, MD, MPH DefinitionIslet 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 people with chronic, uncontrolled type 1 (and some type 2) diabetes.
Reasons for Procedure TOPPancreatic 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 without symptoms and/or those who have very difficult to control blood sugars.
The transplant reduces, or even may eliminate, the need for self-injection. Possible Complications TOPProblems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications, such as: What to Expect TOPPrior to ProcedureA 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. AnesthesiaLocal or general anesthesia may be used. Local anesthesia will numb the area. You will be asleep with general anesthesia. Description of Procedure TOPPancreas islet cell transplantation is a complicated procedure and requires special expertise in select medical centers. The cells are delicate, difficult to isolate, and may fail even in the best of circumstances. Before the procedure, islet cells are removed from a donor pancreas. They are purified before being injected in to the patient. A small 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 TOPYour blood glucose will be controlled with insulin immediately following transplantation. It will take time for new blood vessels to form and insulin to be produced 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? TOPGenerally several hours How Much Will It Hurt? TOPAnesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications. Average Hospital Stay TOP4-10 days Post-procedure Care TOPAt the Hospital
Your doctor may repeat the process several times to transfer more islet cells. Preventing InfectionDuring your stay, the hospital staff will take steps to reduce your chance of infection, such as:
There are also steps you can take to reduce your chance of infection, such as:
Call Your Doctor TOPIt is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
If you think you have an emergency, call for medical help right away. RESOURCES:American College of Surgeons https://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:Ahearn A, Parekh J, Posselt A. Islet transplantation for Type 1 diabetes: where are we now?
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Michael Woods, MD, FAAP Last Updated: 8/29/2017 | |
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