Allogeneic transplantation of isolated islet cells in clinical practice

The only clinically acceptable radical treatment for patients with insulin-dependent diabetes mellitus is a whole pancreas transplantation, or alternatively an infusion of isolated islet cells into the hepatic portal venous system. Allogeneic transplantation of isolated islet cells is a procedure used only in a highly specific group of recipients, whereas intensive insulin treatment still remains the best therapy to achieve glycemia control in most patients with type 1 diabetes. Two groups of allograft recipients should be taken into consideration when scheduled for islet cell transplantation. The first group comprises allogeneic kidney recipients with a stabilized graft function for >6 months who receive chronic immunosuppression and require transplantation for end-stage renal disease caused by diabetic nephropathy. The second group consists of patients with unsatisfactory glycemic control despite insulin therapy, life-threatening hypoglycemic episodes and a rapid progression of long-term complications. Despite increasingly beneficial outcomes, islet cell transplantation has several limitations. Maintaining normoglycemia without exogenous insulin administration and appropriate selection of immunosuppressive agents to prolong graft survival are the major challenges. The aim of related studies has been to optimize all phases of islet cell transplantation in order to achieve total insulin independence and prolong graft survival.