Who should benefit from diabetes cell therapy?

Area of Science:

• Endocrinology and Metabolism
• Transplantation Immunology
• Diabetology

Background:

• Type 1 diabetes is characterized by insulin deficiency and impaired glucose sensing, leading to complications.
• Stricter diabetes management guidelines emphasize glycemic control (HbA1c) and increasingly consider glucose variability.
• Current therapeutic strategies involve optimized insulin therapy and, for severe cases, islet transplantation.

Purpose of the Study:

• To define criteria for islet transplantation in patients with type 1 diabetes and end-stage kidney disease.
• To outline indications for islet transplantation alone in C-peptide negative patients with difficult-to-manage type 1 diabetes.
• To establish islet transplantation as a clinical research procedure with potential for future routine use.

Main Methods:

• Proposing islet after kidney transplantation for specific diabetic patients ineligible for combined pancreas-kidney transplants.
• Defining criteria for islet transplantation alone, including age, diabetes duration, glycemic control, body weight, renal function, and pregnancy desire.
• Highlighting the need for multidisciplinary team assessment and scoring for patient prioritization.

Main Results:

• Criteria are established for islet transplantation post-kidney transplant in patients with end-stage renal disease.
• Specific patient profiles are identified for islet transplantation alone, focusing on those with brittle diabetes and poor glycemic control despite intensive therapy.
• Islet transplantation is currently considered a clinical research procedure pending further benefit-risk assessment.

Conclusions:

• Islet transplantation offers a potential therapeutic option for carefully selected type 1 diabetes patients with specific complications.
• Further evaluation is required to establish the long-term benefit-risk ratio of islet transplantation.
• Development of a scoring system by a multidisciplinary team may aid in prioritizing patients for islet transplantation.