Beta Cell Replacement Therapy in the 1990's An Overview of Pancreatic and Islet Cell Transplantation

The goal of pancreatic beta cell replacement therapy is to restore normoglycemia in insulinopenic Type I diabetics patients. Pancreas transplantation is now considered a therapeutic option for Type I diabetic patients. It can no longer be considered an experimental procedure. Although a number of techniques have been applied in an attempt to restore normal glucose metabolism in Type I diabetic patients, pancreatic transplantation is the only therapy that consistently achieves normal glycosylated hemoglobin levels, an accomplishment rarely if ever achieved with frequent insulin injections or insulin pump therapy. Restoration of normoglycemia can be accomplished by either selectively transplanting isolated pancreatic islet cells or by transplanting the pancreas, usually as a composite graft of duodenum and whole pancreas. At this time, the likelihood of achieving independence from insulin is greater with a whole pancreas transplant than with an islet transplant. However, considerable progress in the field of islet transplantation has been made. This chapter will review the state of pancreas and islet transplantation.