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 people with chronic, uncontrolled type 1 (and some type 2) diabetes.

The Pancreas

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 without symptoms and/or those who have very difficult to control blood sugars.

Hypoglycemia occurs when the person is not eating enough, if too much insulin is self-injected, or when injected insulin to fails to adapt to changes in the body's glucose use, such as with intense exercise.
It can cause serious problems if it lasts too long, such as in someone who does not know it is happening.
Newly transplanted islet cells can produce insulin. This allows better daily control of the blood sugars with a lower risk of hypoglycemia.

The transplant reduces, or even may eliminate, the need for self-injection.

Possible Complications

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:

Smoking
Drinking
Chronic diseases, such as diabetes or obesity

What to Expect

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 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

Your 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?

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

You will learn 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

It 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:

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
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? Expert Rev Clin Immunol. 2015 Jan;11(1):59-68.

Diabetes mellitus type 1. EBSCO DynaMed Plus website. Available at: http://www.dynamed... . Updated August 29, 2016. Accessed August 29, 2017.

Islet Transplant for Type 1 Diabetes. University of California San Francisco website. Available at:
...(Click grey area to select URL)
Accessed August 29, 2017.

Leitao CB, Cure P, Tharavanij T, Baidal DA, Alejandro R. Current challenges in islet transplantation. Curr Diab Rep. 2008;8(4):324-331.

Pancreatic Islet transplantation. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments/pancreatic-islet-transplantation. Updated September 2013. Accessed September 19, 2017.

6/3/2011 DynaMed Plus Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance http://www.dynamed... : Mills E, Eyawo O, Lockhart I, et al. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144-154.

Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP
Last Updated: 8/29/2017

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