[Transplantation in the treatment of diabetes]

Diabetes mellitus continues to be the most common cause of chronic kidney failure, blindness acquired in adulthood, non-traumatic amputations and severe forms of neuropathy. Therefore it is necessary to look for new forms of therapy capable of achieving long-term normalisation of blood sugar levels. The only standard method so far is pancreas transplantation. Most often, it is performed in combination with kidney transplantation and only exceptionally as an isolated procedure. A new and considerably less invasive option is transplantation of isolated Langerhans islets. While the number of pancreas transplantations in IKEM has exceeded 300, the program of islet transplantation is in its formative phase, with 10 clinical surgeries having been performed since May 2007. However, the number of suitable patients who could benefit from this method of treatment largely exceeds the availability of organs suitable for transplantation. Therefore, new possibilities of acquiring insulin producing cell lines are searched for, both from animal tissue and, primarily, from embryonic or adult stem cells. Also the possibility of in vivo regeneration of endogenous or transplanted beta cells of the pancreas has now became an object of study. Combined transplantation of the kidney and pancreas is still the best available method in the treatment of uremic type 1 diabetes patients and its long-term results have shown to be very good, even though their further improvement has been but of a lesser degree. Isolated transplantation of the pancreas is still reserved for a limited group of patients with very labile diabetes. The transplantation of isolated Langerhans isletes is an alternative option which is far safer for the patient, but the long-term results of which still leave much to be desired. The method currently used in the Institute of Clinical and Experimental Medicine (IKEM) is organ transplantation of the pancreas while a program of transplantation of isolated islets has been launched, and also studied are the possibilities of insulin producing cell lines propagation.