Human islet allotransplantation: world experience and current status

Area of Science:

• Endocrinology
• Transplantation immunology
• Regenerative medicine

Background:

• Type-I diabetes mellitus (TDM1) management relies on exogenous insulin, which fails to prevent long-term complications.
• Current TDM1 therapies lack physiological insulin replacement, necessitating alternative strategies.
• Whole organ pancreas transplantation is effective but carries significant surgical risks and complications.

Purpose of the Study:

• To review the historical aspects, indications, and procedures for human islet of Langerhans allotransplantation.
• To evaluate the efficacy and safety of islet transplantation as an alternative to whole organ pancreas transplantation.
• To analyze the outcomes of islet transplantation, including insulin independence and glycemic regulation.

Main Methods:

• Review of clinical trials and data from the International Islet Registry.
• Analysis of historical data, patient indications, and islet isolation/purification techniques.
• Evaluation of graft function, insulin independence, and glycemic control post-transplantation.

Main Results:

• Human islet allotransplantation has been performed in clinical trials since 1990.
• At the end of 1995, 305 human islet allografts were recorded.
• One-year insulin independence was achieved in 8% of patients, with 20% demonstrating graft function and improved glycemic control.

Conclusions:

• Islet transplantation is a less invasive and safer alternative to whole organ pancreas transplantation for TDM1.
• Successful islet transplantation can lead to improved glycemic regulation and potentially insulin independence.
• Further research and refinement of islet transplantation techniques are warranted to enhance patient outcomes.