Outcome of human islet isolation and allotransplantation in 20 consecutive cases

This report provides our initial experience on islet isolation and intrahepatic allotransplantation in 20 patients. In Group 1, 10 patients underwent combined liver-islet allotransplantation following upper-abdominal exenteration for cancer. One patient underwent pancreatic islet allograft after near total pancreatectomy for chronic pancreatitis. In Group 2, 3 Type I diabetic patients received a combined liver-islet allograft for cirrhosis and diabetes. In Group 3, 7 Type I diabetic patients received 8 combined cadaveric kidney-islet grafts (one retransplant) for end stage renal disease. The islets were separated by a modification of the automated method for human islet isolation and the preparations were infused into the portal vein. Immunosuppression was with FK-506 (Group 1) plus steroids (Groups 2 and 3). Six patients in Group 1 did not require insulin treatment for 5 to >16 mo. In Groups 2 and 3 none of the patients became insulin-independent, although ongoing C-peptide secretion, decreased insulin requirement and stabilization of diabetes were observed. Our results indicate that islet transplantation is most effective in pancreatectomy induced diabetes. However, rejection is still a major factor limiting the clinical application of islet transplantation in patients with Type I diabetes mellitus. Other factors such as steroid treatment may contribute to deteriorate islet engraftment and/or function.