Pancreas and islet cell transplantation

Abstract

Currently, for the patient with type 1 diabetes, a definitive treatment without resorting to the use of exogenous insulin can be achieved only with pancreas or islet cell transplantation. These means of restoring beta-cell mass can completely maintain essentially normal long-term glucose homeostasis, although the need for powerful immunosuppressive regimens limits their application to only a subgroup of adult patients. Apart from the shortage of donors that has limited all kinds of transplantation, however, the widespread use of beta-cell replacement has been precluded until recently by the drawbacks associated with both organ and islet cell transplantation. Although the study of recurrence of diabetes has generated attention, the fundamental obstacle to pancreas and islet transplantation has been, and remains, the alloimmune response. With a better elucidation of the mechanisms of alloengraftment achieved during the last 3 years, the stage has been set for further advances.

Figure 1

Whole pancreas allotransplantation with exocrine secretion drainage directly into the host jejunum.

Figure 2

Pancreatico-duodenal allotransplantation with exocrine secretion drainage into the host jejunum.

Figure 3

Pancreatico-duodenal allotransplantation with exocrine secretion drainage into the host bladder.

Figure 4

Contemporaneous host-versus-graft (HVG) and graft-versus-host (GVH) responses following organ transplantation. Reproduced from Starzl TE and Zinkernagel RM (2001, Nature Reviews in Immunology 1: 233–239) with permission.

Figure 5

Total number of pancreas transplants as reported by the International Pancreas Transplant Registry, as of August 2001. Reproduced from Newsletter 13(1), 2001, with permission from the International Pancreas Transplant Registry.