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Review
. 2018 Oct 8;3(1):34-42.
doi: 10.1002/ags3.12214. eCollection 2019 Jan.

Current state and future evolution of pancreatic islet transplantation

Takayuki Anazawa  1 , Hideaki Okajima  1 , Toshihiko Masui  1 , Shinji Uemoto  1
Affiliations
Review

Current state and future evolution of pancreatic islet transplantation

Takayuki Anazawa et al. Ann Gastroenterol Surg. .

Abstract

Pancreatic islet transplantation provides an effective treatment option for patients with type 1 diabetes (T1D) with intractable impaired awareness of hypoglycemia and severe hypoglycemic events. Currently, the primary goal of islet transplantation should be excellent glycemic control without severe hypoglycemia, rather than insulin independence. Islet transplant recipients were less likely to achieve insulin independence, whereas solid pancreas transplant recipients substantially had greater procedure-related morbidity. Excellent therapeutic effects of islet transplantation as a result of accurate blood glucose level-reactive insulin secretion, which cannot be reproduced by current drug therapy, have been confirmed. Recent improvement of islet transplantation outcome has been achieved by refinement of the pancreatic islet isolation technique, improvement of islet engraftment method, and introduction of effective immunosuppressive therapy. A disadvantage of islet transplantation is that donors are essential, and donor shortage has become a hindrance to its development. With the development of alternative transplantation sites and new cell sources, including porcine islet cells and embryonic stem/induced pluripotent stem (ES/iPS)-derived β cells, "On-demand" and "Unlimited" cell therapy for T1D can be established.

Keywords: islet isolation; islet transplantation; regenerative medicine; severe hypoglycemic event; type 1 diabetes.

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Figures

Figure 1
Figure 1
Process to islet transplantation and factors that contribute to islet loss. Procurement of pancreas from the deceased donor and preservation, islet isolation; pancreatic islets are then transplanted into the portal vein. Islets are lost during these processes due to the influence of many factors. Attempts to avoid loss as a result of these factors are important for improving islet transplantation outcome. BMI, body mass index; HbA1c, hemoglobin A1c; HMGB1, high‐mobility group box 1; IBMIR, instant blood‐mediated inflammatory reaction
See this image and copyright information in PMC

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