Islet Transplantation

Excerpt

Transplanting islets of Langerhans consists of the infusion of purified endocrine pancreatic tissue, typically into the hepatic portal system of the recipient. The field of islet transplantation has evolved significantly since the pioneering experiments of Minkowski and von Mering in 1882, with remarkable acceleration over the past four decades thanks to continuous improvements in islet isolation, transplantation techniques, patient management, and immunosuppressive strategies. Restoration of beta-cell function can be achieved by transplantation of allogeneic islets in both non-uremic patients (Islet Transplant Alone, ITA) and those with end-stage renal disease (Simultaneous Islet-Kidney, SIK; Islet-After-Kidney, IAK). Clinical trials and registries have demonstrated long-term sustained function and improved metabolic control, even in recipients requiring exogenous insulin due to suboptimal islet mass or progressive graft dysfunction. Preservation of endogenous insulin secretion is consistently achieved in recipients of islet autografts, a therapeutic option particularly valuable for individuals undergoing total pancreatectomy for non-malignant diseases and, more recently, for selected neoplastic conditions. The clinical and scientific recognition of islet transplantation has been reinforced by regulatory milestones, including the 2023 FDA licensure of allogeneic islets (donislecel-jujn, Lantidra) in the United States and the publication of harmonized good practice guidelines by the European Directorate for the Quality of Medicines (EDQM, 2024). In parallel, long-term outcome data from national cohorts confirm durable graft survival beyond 20 years in a subset of recipients, with protection from severe hypoglycemia in nearly all cases. In addition, islet transplantation represents a powerful platform for the development of next-generation β-cell replacement strategies, including stem cell–derived islets, encapsulation technologies, and genetically engineered cell products. These innovations are expected to broaden access and reduce the need for chronic immunosuppression. In this chapter, we review the current state of clinical islet transplantation and discuss future perspectives in the field. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.